Feasibility study of transanal total mesorectal excision

Velthuis, Simone; Boezem, Peter B. van den; Peet, Donald L. van der; C, Ma; Sietses, C.

doi:10.1002/bjs.9069

Cited by 88 publications

(94 citation statements)

References 10 publications

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“…Neoadjuvant treatment was given to 81% of patients for locally advanced tumors (Table 1). 104,[107][108][109][110][111][112][113][114][115] Mean operative time was 272.5 min (range 120-460), with a mean of 2.8 abdominal trocars used (range 1-5), mean estimated blood loss of 77.8 mL (range 10-300), and mean LOS of 10.2 days (range . The overall intraoperative complication rate was 8.3%, including a 2.8% incidence of conversion to open surgery.…”

Section: Notes Transanal Rectosigmoid Resection: Clinical Trialsmentioning

confidence: 99%

“…All TME specimens were complete, and 94% had negative margins (Tables 2,3). 104,[107][108][109][110][111][112][113][114][115] …”

Section: Notes Transanal Rectosigmoid Resection: Clinical Trialsmentioning

confidence: 99%

“…115 Sylla et al was the only study to specifically exclude nodepositive tumors; of the patients in the remaining trials with recorded preoperative node status, 13% were node positive. The majority of patients with T3 tumors, and two patients with T2 tumors, 110,113 received neoadjuvant chemoradiation. In most series, patients were highly selected, with exclusion criteria including BMI >35, T4 or recurrent tumors, 108,114 and prior extensive abdominal or pelvic surgery.…”

Section: Patient Selectionmentioning

confidence: 99%

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Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES)

Emhoff

Lee

Sylla

2013

Digestive Endoscopy

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The surgical management of rectal cancer has evolved over the past century, with total mesorectal excision (TME) emerging as standard of care. As a result of the morbidity associated with open TME, minimally invasive techniques have become popular. Natural orifice translumenal endoscopic surgery (NOTES) has been held as the next revolution in surgical techniques, offering the possibility of 'incisionless' TME. Early clinical series of transanal TME with laparoscopic assistance (n = 72) are promising, with overall intraoperative and postoperative complication rates of 8.3% and 27.8%, respectively, similar to laparoscopic TME. The mesorectal specimen was intact in all patients, and 94.4% had negative margins. There was no oncological recurrence in average-risk patients at short-term follow up, and 2-year survival rates in high-risk patients were comparable to that after laparoscopic TME. These preliminary studies demonstrate transanal NOTES TME with laparoscopic assistance to be clinically feasible and safe given careful patient selection, surgical expertise, and appropriate procedural training. We are hopeful that with optimization of transanal instruments and surgical techniques, pure transanal NOTES TME will become a viable alternative to open and laparoscopic TME in the future.

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Section: Notes Transanal Rectosigmoid Resection: Clinical Trialsmentioning

confidence: 99%

“…All TME specimens were complete, and 94% had negative margins (Tables 2,3). 104,[107][108][109][110][111][112][113][114][115] …”

Section: Notes Transanal Rectosigmoid Resection: Clinical Trialsmentioning

confidence: 99%

Section: Patient Selectionmentioning

confidence: 99%

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Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES)

Emhoff

Lee

Sylla

2013

Digestive Endoscopy

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“…The macroscopic quality of TME was documented in all published reports, except in study of Wolthuis et al [103] and has been reported as ''intact'' [110] , ''adequate'' [111,112] , ''satisfactory'' [104,113] , or ''complete'' [11,12,106,107,111,114] .…”

Section: Oncological Outcomesmentioning

confidence: 99%

Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes

Dimitriou

Michail

Moris

et al. 2015

WJGO

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Low rectal cancer is traditionally treated by abdominoperineal resection. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity and to improve both the oncological as well as the functional outcomes, have been emerged. Literature suggest that when the intersphincteric resection is applied in T1-3 tumors located within 30-35 mm from the anal verge, is technically feasible, safe, with equal oncological outcomes compared to conventional surgery and acceptable quality of life. The Anterior Perineal PlanE for Ultra-low Anterior Resection technique, is not disrupting the sphincters, but carries a high complication rate, while the reports on the oncological and functional outcomes are limited. Transanal Endoscopic MicroSurgery (TEM) and TransAnal Minimally Invasive Surgery (TAMIS) should represent the treatment of choice for T1 rectal tumors, with specific criteria according to the NCCN guidelines and favorable pathologic features. Alternatively to the standard conventional surgery, neoadjuvant chemo-radiotherapy followed by TEM or TAMIS seems promising for tumors of a local stage T1sm2-3 or T2. Transanal Total Mesorectal Excision should be performed only when a board approved protocol is available by colorectal surgeons with extensive experience in minimally invasive and transanal endoscopic surgery. Core tip: The present review presents the most recent advances in the field of sphincter preserving surgery for the treatment of low rectal cancer patients, providing indications, patients' selection, surgical techniques, multimodality approaches, postoperative course and oncological and functional outcomes. In particular, the review focuses on data deriving from prospective EDITORIAL

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“…Atallah et al published the first series of TAMIS-TME in 20 patients with rectal cancer [2]. Although evidence on the efficacy of TAMIS-TME in rectal cancer has been accumulating [3,4]. there is scarce data on its use in inflammatory bowel disease.…”

Section: Introductionmentioning

confidence: 99%

Transanal total mesorectal excision (TaTME) for inflammatory bowel disease (IBD): review of technique and initial experience

et al. 2017

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IntroductionTrans anal minimal invasive surgery (TAMIS) is a novel technique gaining popularity in colorectal surgery due to its precision in pelvic dissection and easy accessibility to the distal rectum. Its use in colorectal cancer surgery is well documented although inflammatory bowel disease (IBD) poses a unique set of disease-specific and procedure-related challenges. Unlike in cancer surgery, the wide disease spectrum with varying morphological changes in IBD would require the surgeon to adapt accordingly from port insertion to wound closure. This article describes our experience with the first 60 procedures. MethodologyPatients affected by IBD requiring proctectomy with or without total colectomy from 2013 to 2016 were offered Trans anal total mesorectal excision (TaTME) on a TAMIS and Single Incision Laparoscopy (SILS) combined platform. Airseal ® insufflation on GelpointPath ® platform with monopolar diathermy was used for rectal surgery. A second team using ultrasonic dissection carried out concomitant abdominal dissection. Procedural modifications were adopted based on authors' personal experience. Standard ileoanal S pouch with stapler anastomosis was performed. Surgical time, blood loss and patient demographics were recorded. ResultsAll 60 patients (male -44; median age 42.5; range 19-75) presented during the study period underwent TaTME for the rectal dissection with an 8% conversion rate. Of the total 38 (63%) were done for ulcerative colitis and the perineal phase has taken a median time of 141.8 minutes. Ileo-anal pouch surgery was performed in 27 (45%) patients. Two patients (3.3%) required re-intervention due to complications in the abdominal procedure. Two patients required vacuum dressing for wound closure. ConclusionTaTME is a safe and feasible procedure in IBD surgery. Specific difficulties due to the inflammatory process which results in difficult dissection can be overcome with attention to anatomical details and the use of specific instruments. 1,2 2 2 2

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Feasibility study of transanal total mesorectal excision

Cited by 88 publications

References 10 publications

Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES)

Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES)

Low rectal cancer: Sphincter preserving techniques-selection of patients, techniques and outcomes

Transanal total mesorectal excision (TaTME) for inflammatory bowel disease (IBD): review of technique and initial experience

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