腫瘍外科アーカイブ

Transanal total mesorectal excision (TA-TME) for a bulky low rectal cancer in a patient with a narrow pelvis

Abstract

Dr Vinay Gaikwad

One the of the most difficult steps when operating mid and low rectal cancer is performing a neat transection of the distal segment while attaining negative margins both longitudinally as well as circumferentially. This technical difficulty is aggravated further in patients with a narrow pelvis and/or bulky tumors. Since the space in the pelvis may be restricted and with large tumors, vision is impaired and accessibility to the distal transection margin is hampered. Using the principles of transanal microsurgery, the TA-TME procedure is an extrapolation intended to assist surgeons to perform a complete TME under vision while maintaining comfortable ergonomics. The essence of the procedure is that the TME performed transabdominally can be completed through a transanal route. This procedure, no doubt, requires additional equipment such as a transanal gel port system and a separate laparoscopic tower is also desirable. This procedure also obviates the need for stapler transection of the distal end. The anastomosis can be performed either with a circular stapler or by a hand-sewn technique. This video takes us through the TA-TME procedure is a step-wise fashion with an easy-to-learn description