Robotic transanal total mesorectal excision: A new perspective for low rectal cancer treatment. A case series

Abstract Background: Rectal cancer located in distal third still remains a technical challenge for surgeons. Transanal total mesorectal excision with laparoscopic assistance is quite new surgical approach for rectal cancer treatment that seems to solve some of the associated technical issues. The aim of the study was to present our experience in laparoscopy-assisted transanal total mesorectal excision. Materials and methods: After obtaining approval from the local Ethics Committee, a single centre prospective double-arm comparative non-randomized trial was initiated. With recruiting still in progress at present, between 27.02.2017 and 01.10.2017 four laparoscopy-assisted transanal total mesorectal excision procedures and two laparoscopic total mesorectal excisions were performed in the department of Endoscopic Endocrine Surgery and Coloproctolgy at the Military Medical Academy in Sofia. Results: There is no conversion in both groups. No postoperative mortality 30 days after surgery. The quality of total mesorectal excision was satisfactory in all patients estimated by the Quirque classification. There was no distal or proximal tumor involvement of surgical margins. In one of the cases, we reported positive circumferential resection margin. We had two cases with postoperative morbidity. Conclusion: Transanal total mesorectal excision with laparoscopic assistance is quite new minimally invasive surgical approach for rectal cancer treatment. Avoiding the procedure-related complications during the learning curve is essential before applying the method to every patient. Multicenter randomized control trial is needed so that we could answer the questions raised in this study.

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Robotic transanal total mesorectal excision combined with intersphincteric resection for ultra-low rectal cancer

Techniques in Coloproctology ◽

10.1007/s10151-021-02494-9 ◽

2021 ◽

Author(s):

F. Li ◽

F. Zhang ◽

D. Tan ◽

J. Ye ◽

W. Tong

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Intersphincteric Resection ◽

Low Rectal Cancer ◽

Transanal Total Mesorectal Excision ◽

Mesorectal Excision ◽

Robotic Transanal

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Transanal Total Mesorectal Excision (TaTME): Experience in Klaipėda University Hospital

Lietuvos chirurgija ◽

10.15388/lietchirur.2019.18.15 ◽

2019 ◽

Vol 18 (4) ◽

pp. 235-238

Author(s):

Vita Klimašauskienė ◽

Narimantas Evaldas Samalavičius

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Cancer Treatment ◽

Dentate Line ◽

University Hospital ◽

Lithotomy Position ◽

Transanal Total Mesorectal Excision ◽

Mesorectal Excision ◽

Rectal Cancer Treatment ◽

Laparoscopic Tme

Introduction. Colorectal cancer ranks third on the list of the most common cancers. In 1979 R. J. Heald described total mesorectam excision (TME) which became a gold standard for rectal cancer treatment. This operation is performed all over the world open, laparoscopic and robotic. Operating on low and very low rectal cancer, distal bowel mobilisation if often the most difficult part of the operation. Aa a solution to this problem transanal abdominotransanal rectal resection (TATA) and transanal total mesorectal excision (TaTME) were proposed. This article reviews the experience and short-term postoperative outcomes of TaTME performed in Klaipėda University Hospital.Methods. The first stage of surgery was performed with patient placed in the prone jackknife (Kraske) position. Using electrocauthery circular mobilisation of the rectum was performed starting at least 1 cm from the lower edge of the tumour. Up to 10 cm of the rectum was mobilised from below. The second stage was performed with patient in lithotomy position. Laparoscopic TME was performed. For 11 (78.57%) patients hand sown anastomosis was performed and for 1 (7.17%) patient stapler was used. 2 (14.28%) patients underwent the Hartmann’s procedure.Results. In period 2018.03–2019.10 TaTME was performed for 14 patients. The medium tumour high counting from dentate line was 2.54 (±1.28). 13 out of 14 patients were operated from 8 to 12 weeks after chemoradiotherapy. All (100%) rectal resections were radical (R0). On average 11.43 (±3.78) lymphnodes were harvested. 5 (35.71%) patients had complications after surgery.Conclusions. TaTME performed at Klaipėda University Hospital is effective operation for rectal cancer treatment.

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Rectal cancer treatment by transanal total mesorectal excision: Results in 100 consecutive patients

Cirugía Española (English Edition) ◽

10.1016/j.cireng.2019.10.009 ◽

2019 ◽

Vol 97 (9) ◽

pp. 510-516

Author(s):

Vicente Simó ◽

Jorge Arredondo ◽

Cristina Hernán ◽

Luís Miguel Jiménez ◽

Benedetto Ielpo ◽

...

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Cancer Treatment ◽

Transanal Total Mesorectal Excision ◽

Mesorectal Excision ◽

Rectal Cancer Treatment

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Peer review report 1 on “Total Mesorectal Excision, an erroneous anatomical term for the gold standard in rectal cancer treatment”

International Journal of Surgery ◽

10.1016/j.ijsu.2015.10.023 ◽

2015 ◽

Vol 13 ◽

pp. S184

Author(s):

Raafat Yahia Afifi

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Cancer Treatment ◽

Peer Review ◽

Gold Standard ◽

Mesorectal Excision ◽

Rectal Cancer Treatment ◽

Anatomical Term

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Glove single-port laparoscopy-assisted transanal total mesorectal excision for low rectal cancer: a preliminary report

World Journal of Surgical Oncology ◽

10.1186/s12957-019-1744-z ◽

2019 ◽

Vol 17 (1) ◽

Author(s):

Wanglin Li ◽

Boye Dong ◽

Baifu Peng ◽

Jiabao Lu ◽

Zixin Wu ◽

...

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Hospital Stay ◽

Single Port ◽

Low Rectal Cancer ◽

Transanal Total Mesorectal Excision ◽

Mesorectal Excision ◽

Single Port Laparoscopy ◽

The Mean

Abstract Purpose Glove single-port laparoscopy-assisted transanal total mesorectal excision (TaTME) has been successfully carried out in our medical center. The purpose of this study is to evaluate the feasibility of this emerging operation. Methods This technique was performed by self-made glove single-port laparoscopic platform to radically resect low rectal cancer. Short-term postoperative results, including complications, length of hospital stay, and follow-up results were collected and analyzed statistically. Results There are five consecutive patients (three males, two females) who underwent this surgery and included in this study. The mean distance from the tumor to the anal verge was 4.8 cm (range 4.0–6.0). The surgery was completed in all cases, and the rectal tumor was removed successfully without conversion; circumferential margins of all the excised specimens were negative. The mean time of operation was 338.00 min (range 280–400). The average number of lymph node dissection was 12.20. The average postoperative hospital stay was 8.60 days. During the follow-up (14.80 ± 1.92 months), all preventive ileostomies were successfully closed in about 3 months after the surgery, all patients had satisfactory anal function, and no tumor recurrence was found. Conclusion Glove single-port laparoscopy-assisted TaTME has a significant effect in specific patients with low rectal cancer, with rapid recovery and high safety. Prospective randomized studies involving more case counts and long-term follow-up results, especially oncologic outcomes, are needed to validate this technique.

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