Transanal Total Mesorectal Excision With Single-Incision Laparoscopy for Rectal Cancer

Abstract

Background and Objectives:There has been great enthusiasm for the technique of transanal total mesorectal excision. Coupled with this procedure, we performed single-incision laparoscopic surgery for left colon mobilization. This is a description of our initial experience with the combined approach.Methods:Patients with distal or mid rectal cancer were included. The operation was performed by 2 teams: one team performed the single-incision mobilization of the left colon via the right lower quadrant ileostomy site, and the other team performed the total mesorectal excision with a transanal platform.Results:During the study period, 10 patients (5 men) with cancer of the rectum underwent the surgery. The mean age was 62.2 ± 11.1 years, and the mean body mass index was 23.4 ± 3.2 kg/m2. The tumor's mean distance from the anal verge was 5.1 ± 2.5 cm. The median operating time was 247.5 minutes (range, 188–462 minutes). The mean estimated blood loss was 124 ± 126 mL (range, 10–188 mL). Conversion to multiport laparoscopy was needed in one case (10%). Postoperative pain, as reflected by the pain score, was minimal. The mean number of lymph nodes harvested was 15.6 ± 3.8. All specimens had clear distal and circumferential radial margins. The overall complication rate was 10%.Conclusion:Our experience showed transanal total mesorectal excision with single-incision laparoscopy to be a feasible option for rectal cancer. Patients reported minimal postoperative pain. Further studies on the long-term outcome are warranted.

Single-incision laparoscopy surgery: a systematic review

“…Patients reported minimal postoperative pain. Further studies on the long-term outcome are warranted (33). The first experience with this minimally invasive approach was demonstrated.…”

Application of transanal endoscopic operation device in laparoscopic assisted transanal total mesorectal excision for the treatment of ultra‐low rectal carcinoma

“…Cohort studies have shown the feasibility of this new technique and 1,2 improved total mesorectal excision (TME) specimen quality, potentially minimizing surgical morbidities. [9][10][11][12][13] GelPOINT Path Transanal Access Platform (Applied Medical, Rancho Santa Margarita, CA, USA) is currently the commonly-used adjunct because of its flexibility and air-sealing quality during transanal dissection. 7,8 of The TaTME technique has been applied in conjunction with various traditional procedures to achieve maximal benefits to patients.…”

“…7,8 of The TaTME technique has been applied in conjunction with various traditional procedures to achieve maximal benefits to patients. [9][10][11][12][13] GelPOINT Path Transanal Access Platform (Applied Medical, Rancho Santa Margarita, CA, USA) is currently the commonly-used adjunct because of its flexibility and air-sealing quality during transanal dissection. However, it is difficult to establish stable imaging and results in extra costs to the health-care system because of the costly single-use consumables.…”

“…With the procedure being standardized in a step‐by‐step manner, it potentially improves the functional outcome of rectal resections . of The TaTME technique has been applied in conjunction with various traditional procedures to achieve maximal benefits to patients . GelPOINT Path Transanal Access Platform (Applied Medical, Rancho Santa Margarita, CA, USA) is currently the commonly‐used adjunct because of its flexibility and air‐sealing quality during transanal dissection.…”

Transanal total mesorectumectomy with D3-lymphodissection through a single laparoscopic approach

“…Все авторы размещали порт для ЕЛД либо в умбиликальной области, когда не планировали превентивную илеостому, либо в правом мезогастрии на месте будущей стомы [21][22][23][24][25]. Во всех описанных случаях практиковали высокое лигирование нижних брыжеечных сосудов с D3лимфодиссекцией [21][22][23][24][25][26]. Страховой дренаж выводили либо через контрапертуру на передней брюшной стенке [25], либо параректально [24].…”