Transanal TME: new standard or fad?

Hasegawa, Suguru; Yoshida, Yoichiro; Morimoto, Mitsuaki; Kojima, Daibo; Komono, Akira; Aisu, Naoya; Taketomi, Hirotaka; Nagano, Hideki; Matsumoto, Yoshiko; Munechika, Taro; Kajitani, Ryuji

doi:10.23922/jarc.2018-030

Cited by 8 publications

(6 citation statements)

References 69 publications

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“…However, in the prone jackknife position the mobilized rectum could spontaneously move toward the head in response to gravity, without the sacral bone restraint 10–12 . The best indication for this procedure is difficult APR from an abdominal approach, such as bowel obstruction or a bulky tumor 12,13 …”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12] The best indication for this procedure is difficult APR from an abdominal approach, such as bowel obstruction or a bulky tumor. 12,13 The disadvantages of this procedure are the difficulty immediately changing the patient's posture in an emergency, slight difficulty ensuring the contour of the NVB under the visceral pelvic fascia from the transperineal view alone, and difficulty reducing the surgical time with only one team. 7,10,11 If cancer involves the adjacent organs of the anterior anorectum, these organs should be resected along or close to each anatomical landmark, such as the STL, TALAM, or NVB.…”

Section: Discussionmentioning

confidence: 99%

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Transperineal abdominoperineal resection in the prone jackknife position in male patients with low rectal cancer

Uematsu

Sugihara

2021

Asian J Endoscop Surgery

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Introduction:In male patients with low rectal cancer undergoing abdominoperineal resection (APR), successful dissection of the anterior anorectum is key to reducing the risk of circumferential resection margin involvement, intraoperative bowel perforation, and local recurrence, but it is challenging.To overcome difficulties dissecting the anterior anorectum, we present a safe and feasible procedure using a transperineal endoscopic approach during APR (TpAPR). Materials and Surgical Technique:The male patient is placed in the prone jackknife position. TpAPR precedes the procedure from an abdominal approach.We use some pelvic tissues as clear anatomical landmarks to dissect the anterior anorectum. The key steps of this procedure are shown in the video. Discussion: The identification of a clear anatomical dissection plane of the anterior anorectum is difficult because of the complex surgical anatomy of the region. Clear anatomical landmarks for dissection of the anterior anorectum are necessary for safe implementation of this procedure. Therefore, TpAPR in the prone jackknife position can be performed to obtain better visualization of each anatomical landmark at a glance.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Transperineal abdominoperineal resection in the prone jackknife position in male patients with low rectal cancer

Uematsu

Sugihara

2021

Asian J Endoscop Surgery

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“…Urethral injuries rarely occur during transabdominal rectal resections but may occur during abdominoperineal resections and TaTME [20]. In the LoREC Development Program International TaTME registry, the incidence of urethral injury has been reported to be 0.8% [21], with the majority of injuries occurring in the early phase of the learning curve [22].…”

Section: Discussionmentioning

confidence: 99%

“…After that, the first case at each centre was performed under the guidance of a proctor and all relevant data regarding the patients and results were to be registered on the international TaTME database [25]. These structured training pathways led to good histopathological outcomes, including complete mesorectal excision (corresponding to mesorectal plane of dissection) in 89%-100% of cases and a positive CRM in 2%-5% of cases [19][20][21]. Finally, in the Netherlands, after the training pathway period, nationwide prospective data have shown outcomes comparable to those of laparoscopic TME in a propensity score matched analysis [26].…”

Section: Other Countries Have Successfully Implemented Training Pathwaysmentioning

confidence: 99%

Short‐term outcomes after transanal total mesorectal excision for rectal cancer in Denmark – a prospective multicentre study

et al. 2020

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Aim:The aim of this study was to evaluate the short-term surgical and oncological outcomes after transanal total mesorectal excision (TaTME) for rectal cancer during the implementation phase of this procedure in Denmark.Method: This is a retrospective review of prospectively recorded data. Registration was initiated by the Scientific Council of the Danish Colorectal Cancer Group (DCCG.dk) in order to assess the quality of care during the implementation of TaTME. Pre-, intra-and postoperative data including early recurrences were recorded at the operating centres.Results: From August 2016 to April 2019, 115 TaTME procedures were registered. Patients were predominantly male (74%) with mid-rectal (88%) tumours. The level of surgical complications was comparable to previous nationwide results. Anastomotic leakage occurred in 6/109 (5.5%). One urethral injury occurred. The plane of dissection was mesorectal in 60% of cases, intramesorectal in 28% and muscularis in 12%. Nonmicroradicality was seen in 8% (R1, 6%; R2, 2%). Four local recurrences occurred after a median of 23 months of follow-up. One of these was multifocal. Conclusion:In an implementation phase where patient selection is expected, surgical and oncological results after TaTME were comparable to those of other approaches reported in the literature.

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“…1 surgery is associated with a poor prognosis, a high likelihood of permanent colostomy and a high rate of local recurrence in patients with regional disease (transmural penetration or involvement of regional mesenteric lymph nodes Transanal TME (TaTME) combines abdominal and transanal endoscopic approaches, allows to reduce the abdominal incision and improves the postoperative abdominal pain. 2 such as better exposure of the distal rectum and direct determination of distal resection margin. Although evidence demonstrating the true benefits of taTME over laparoscopic TME (LapTME Transversus abdominis plane (TAP) block is the injection of local anesthetics to neurofascial plane between internal oblique and transversus abdominis muscles and is highly effective in reducing perioperative pain.…”

Section: Introductionmentioning

confidence: 99%

Utility of transversus abdominis plane block on patients undergoing transanal total mesorectal excision

Jin¹,

Jiang²,

Xu³

et al. 2023

Pak J Med Sci

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Objective: To evaluate the analgesic effect of transversus abdominis plane block (TAPB) on patients undergoing transanal total mesorectal excision (taTME). Methods: Medical records of patients who were eligible to receive proctectomy surgery in Renji Hospital, Shanghai Jiao Tong University School of Medicine (From January 2019 to December 2021) were retrospectively reviewed. Propensity score matching (PSM) was applied to the included cases. A total of 120 cases were divided into three groups based on the different operation and anesthesia methods used. Group-A (Lap, n=40) included patients that underwent laparoscopic surgery under general anesthesia. Group- B (ta, n=40) included patients who received taTME surgery under general anesthesia. Group-C (ta+TAPB, n=40) included patients who received taTME surgery under general anesthesia combined with TAPB. The dosage of sufentanil, time of postoperative revival and extubation, anal exhaust time and other adverse events were recorded. Pain assessment using the visual analogue scale (VAS) was performed at 12, 24,48 and 72 hours after the operation. Results: There were no significant differences in the general parameters, operative conditions, and anesthetic administration between the three groups (P>0.05). The dosage of sufentanil was significantly reduced in Group-C, compared with Group-A and Group-B, with no difference between the groups A and B. There was no significant difference between the three groups in postoperative recovery time and extubation time. VAS score was lower in Group-C than Group-A and Group-B. This difference was more obvious in the early postoperative period and gradually diminished with time. VAS score became similar in all three groups 72 hours after the surgery. Conclusion: Transanal total mesorectal excision was associated with less pain, compared to laparoscopic TME. TAPB with general anesthesia in patients undergoing taTME is safe and effective. It can significantly reduce the use of sufentanil and has optimal analgesic effect. List of Abbreviations:taTME: Transanal total mesorectal excision; TAPB: Transversus abdominis plane block; PCIA: Patient controlled intravenous analgesia; VAS: Visual analogue scale;NOSES: Natural orifice specimen extraction surgery; ERAS: Enhanced recovery after surgery. doi: https://doi.org/10.12669/pjms.39.2.7062 How to cite this: Ying J, Jiang C, Xu C, Liu Y, Gu L. Utility of transversus abdominis plane block on patients undergoing transanal total mesorectal excision. Pak J Med Sci. 2023;39(2):---------. doi: https://doi.org/10.12669/pjms.39.2.7062 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Transanal TME: new standard or fad?

Cited by 8 publications

References 69 publications

Transperineal abdominoperineal resection in the prone jackknife position in male patients with low rectal cancer

Transperineal abdominoperineal resection in the prone jackknife position in male patients with low rectal cancer

Short‐term outcomes after transanal total mesorectal excision for rectal cancer in Denmark – a prospective multicentre study

Utility of transversus abdominis plane block on patients undergoing transanal total mesorectal excision

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