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Totale mesorektale Exzision durch den minimal-invasiven transanalen Zugang

Erweiterung der Möglichkeiten

Total mesorectal excision via transanal minimally invasive surgery

An alternative technique

  • Leitthema
  • Published:
coloproctology Aims and scope

Zusammenfassung

Hintergrund

Das anteriore Resektionssyndrom, urogenitale Funktionsstörungen und unzureichende onkologische Radikalität aufgrund einer schlechten Qualität des mesorektalen Präparats sind lebensqualitätsbeeinträchtigende Folgen bei der vorderen tiefen Rektumresektion, die trotz nervenschonenderer laparoskopischer Technik gerade bei anatomischen Limitationen, wie dem engen, adipösen, männlichen Becken oder bei tiefsitzendem Rektumkarzinom, auftreten können.

Fragestellung

Der zusätzliche transanale minimal-invasive Zugang zur totalen mesorektalen Exzision (TAMIS-TME) stellt eine Alternative zur rein abdominellen Technik der totalen mesorektalen Exzision dar und verspricht bessere funktionelle und onkologische Ergebnisse durch eine bessere Übersicht. Ziel der Arbeit ist es, diese neue Technik und die bisher in der Literatur publizierten Ergebnisse vorzustellen.

Material und Methoden

Bei der TAMIS-TME handelt es sich um ein Hybridverfahren aus simultaner laparoskopischer anteriorer Rektummobilisation und TME beim tiefsitzenden Rektumkarzinom. Der transanale Akt wird nach zirkulärer Inzision des Rektums über eine transanale Plattform und Setzen eines Kapnosubperitoneums von kaudal nach kranial durchgeführt.

Ergebnisse

Anatomische Landmarken für einen nervenschonenden und onkologisch radikalen transanalen Zugang werden beleuchtet. Erste Ergebnisse aus der Literatur zeigen die Machbarkeit dieser Technik bei ultratiefen Rektumkarzinomen mit qualitativ hochwertigen mesorektalen Präparaten und akzeptablem funktionellem Outcome.

Diskussion

Die TAMIS-TME stellt eine sphinktererhaltende und nervenschonende Alternative zur Rektumamputation gerade beim engen, adipösen, männlichen Becken und bei tiefsitzendem Rektumkarzinom dar.

Abstract

Background

Low anterior resection syndrome, urogenital disorders and insufficient oncological radicality due to incomplete mesorectal excision following low anterior resections are associated with decreased quality of life. Nerve-oriented laparoscopic approaches have improved functional outcome, however are limited in narrow, male, obese pelvis and ultralow rectal cancer.

Purpose

The transanal minimally invasive approach for total mesorectal excision (TAMIS-TME) is an alternative to anterior resection techniques and promises better functional and oncological outcomes due to better visibility from bottom-to-top. The purpose of this article is to introduce this new technique and highlight preliminary results that were previously published.

Materials and methods

TAMIS-TME is a hybrid technique consisting of simultaneous laparoscopic anterior rectal mobilization and transanal mesorectal excision in ultralow rectal cancer. The transanal part is performed after circular rectal incision and insertion of a rigid or flexible platform with subperitoneal carbon dioxide insufflation.

Results

Anatomical landmarks for a nerve-sparing and oncologically radical transanal approach are described. Preliminary results confirm the feasibility of this technique in terms of ultralow rectal cancer including complete mesorectal specimens and acceptable functional outcome.

Discussion

TAMIS-TME is a sphincter-preserving and nerve-sparing alternative to abdominoperineal rectal excision especially in patients with anatomical constraints and ultralow rectal cancer.

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Correspondence to W. Kneist.

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W. Kneist und F. Aigner geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Kneist, W., Aigner, F. Totale mesorektale Exzision durch den minimal-invasiven transanalen Zugang. coloproctology 37, 253–261 (2015). https://doi.org/10.1007/s00053-015-0034-7

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  • DOI: https://doi.org/10.1007/s00053-015-0034-7

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