Transanal transection and single-stapling techniques are associated with shorter rectal cuff and lower urgency rate after pouch surgery compared with the double-stapled approach

Spinelli, Antonino; Foppa, Caterina; Maroli, Annalisa; Sacchi, Matteo; Armuzzi, Alessandro; Danese, Silvio; Bemelman, Willem A.; Carvello, Michele

doi:10.1016/j.surg.2023.06.027

Cited by 6 publications

(2 citation statements)

References 21 publications

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“…However, challenges arise in very low rectal stumps, prompting the exploration of various methods that focus on eliminating distal linear staple lines [3–5]. One such method, the transanal single‐stapling technique, relies on purse‐string application on the distal rectal transection end to create an end‐to‐end single‐stapled anastomosis [6].…”

Section: Videomentioning

confidence: 99%

Rectal circular stapler anastomosis: A crossover‐free, dog‐earless technique

Abualnaja,

Driver,

Malik

2024

Colorectal Disease

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Section: Videomentioning

confidence: 99%

Rectal circular stapler anastomosis: A crossover‐free, dog‐earless technique

Abualnaja,

Driver,

Malik

2024

Colorectal Disease

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“…The transanal approach to ileal pouch–anal anastomosis (Ta-IPAA), also known as the TaPouch procedure, is a recent surgical technique for creating an ileal pouch–anal anastomosis via a transanal route. This approach is an adaptation of the transanal total mesorectal excision (TaTME) technique used for rectal cancer and has been applied to restorative proctocolectomy for conditions such as ulcerative colitis [ 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 ].…”

Section: Technical Aspects Of Surgical Approachesmentioning

confidence: 99%

Current Management of Acute Severe Ulcerative Colitis: New Insights on the Surgical Approaches

Lauricella,

Brucchi,

Cavalcoli

et al. 2024

JPM

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Acute severe ulcerative colitis (ASUC) is a life-threatening medical emergency with considerable morbidity. Despite recent advances in medical IBD therapy, colectomy rates for ASUC remain high. A scoping review of published articles on ASUC was performed. We collected data, such as general information of the disease, diagnosis and initial assessment, and available medical and surgical treatments focusing on technical aspects of surgical approaches. The most relevant articles were considered in this scoping review. The management of ASUC is challenging; currently, personalized treatment for it is unavailable. Sequential medical therapy should be administrated, preferably in high-volume IBD centers with close patient monitoring and indication for surgery in those cases with persistent symptoms despite medical treatment, complications, and clinical worsening. A total colectomy with end ileostomy is typically performed in the acute setting. Managing rectal stump is challenging, and all individual and technical aspects should be considered. Conversely, when performing elective colectomy for ASUC, a staged surgical procedure is usually preferred, thus optimizing the patients’ status preoperatively and minimizing postoperative complications. The minimally invasive approach should be selected whenever technically feasible. Robotic versus laparoscopic ileal pouch–anal anastomosis (IPAA) has shown similar outcomes in terms of safety and postoperative morbidity. The transanal approach to ileal pouch–anal anastomosis (Ta-IPAA) is a recent technique for creating an ileal pouch–anal anastomosis via a transanal route. Early experiences suggest comparable short- and medium-term functional results of the transanal technique to those of traditional approaches. However, there is a need for additional comparative outcomes data and a better understanding of the ideal training and implementation pathways for this procedure. This manuscript predominantly explores the surgical treatment of ASUC. Additionally, it provides an overview of currently available medical treatment options that the surgeon should reasonably consider in a multidisciplinary setting.

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Enhanced transanal surgery training through a 4K 3D surgical exoscope: a novel approach for transanal surgery

Spinelli,

Chardalias,

Carvello

et al. 2024

Int J Colorectal Dis

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Purpose Recently, exoscope was introduced as a more ergonomic alternative to microscope, mainly in nerve and spinal surgery. Exoscope use in general surgery is still experimental and just few reports are present in literature. Here, we describe for the first time its application in transanal surgery, specifically during the transanal transection and single-stapled anastomosis in ileal-pouch anal anastomosis. Methods After completing the proctectomy and pouch formation laparoscopically, two surgeons performed the transanal transection and single-stapled anastomosis using the vision provided by the ORBEYE™ exoscope system with a 3D 4K orbital camera and a 55-inches 3D screen. The transanal procedure was carried out with the surgeons looking at the 3D screen rather than at the operating field. Results The system subjectively provided excellent operative view thanks to the magnification capacity and the high resolution. The ergonomics was improved compared to classical transanal surgery, allowing the operators and observers to have the same view in a comfortable position. In particular, the exoscope magnified vision allowed for clearer demonstration of techniques to trainees. Conclusions This is the first report on the intraoperative application of the ORBEYE™ surgical exoscope in transanal surgery. The magnified vision allowed precise movements and the system appeared potentially a ground-breaking tool for surgical training. The ability to project high-quality images to observers make it ideal for teaching complex transanal procedures. Further studies are encouraged to validate this approach into standard colorectal practice.

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Transanal transection and single-stapling techniques are associated with shorter rectal cuff and lower urgency rate after pouch surgery compared with the double-stapled approach

Cited by 6 publications

References 21 publications

Rectal circular stapler anastomosis: A crossover‐free, dog‐earless technique

Rectal circular stapler anastomosis: A crossover‐free, dog‐earless technique

Current Management of Acute Severe Ulcerative Colitis: New Insights on the Surgical Approaches

Enhanced transanal surgery training through a 4K 3D surgical exoscope: a novel approach for transanal surgery

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