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Techniques in Coloproctology

, Volume 19, Issue 6, pp 375–375 | Cite as

The use of a lighted stent as a method for identifying the urethra in male patients undergoing transanal total mesorectal excision: a video demonstration

  • S. AtallahEmail author
  • B. Martin-Perez
  • J. Drake
  • P. Stotland
  • S. Ashamalla
  • M. Albert
Video Forum

Keywords

Rectal Cancer Total Mesorectal Excision Unique Approach Foley Catheter Adequate Training 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

The application of transanal minimally invasive surgery (TAMIS) for total mesorectal excision (TME) has undergone rapid adoption by expert colorectal surgeons worldwide [1]. It represents one of the most important new techniques for the management of distal rectal cancer [2]. However, the unique approach from below is unfamiliar to rectal cancer surgeons and mandates appropriate training and education. Even with adequate training, there is a risk of urethral injury with TAMIS-TME [3].

This video demonstrates how the male urethra can be injured during transanal TME and then describes a simple method for identifying the urethra. On a cadaveric model, a clear 24 Fr Foley catheter is introduced into the bladder. Through the Foley, a lighted ureteral stent is placed into the Foley and secured in place. Next, transanal TME trainees are instructed to attempt to injure the urethra with the aim of identifying the urethra prior to transection by identifying the lighted stent. Under normal laparoscopic light, the stent was not visible, but when the light source was toggled to OFF, the lighted stent (within the urethra) was clearly visible.

In summary, this video demonstrates that the use of a lighted stent within a clear Foley catheter can help visualize the urethra and may prevent inadvertent injury during transanal TME.

Notes

Acknowledgments

The authors received no funding for this study, and the research was not supported by any grants or other funding. Dr. S. Atallah is a paid consultant for Applied Medical, Inc. Dr. M. Albert is a paid consultant for Applied Medical and Surgiquest. Dr. B. Martin-Perez and Dr. J. Drake have no disclosures. Dr. P. Stotland and Dr. S. Ashamalla have no disclosures. Part of this video was filmed during a transanal TME course sponsored by Applied Medical, Inc.

Conflict of interest

None.

Supplementary material

Supplementary material 1 (MOV 215920 kb)

References

  1. 1.
    Araujo SE, Crawshaw B, Mendes CR, Delaney CP (2015) Transanal total mesorectal excision: a systematic review of the experimental and clinical evidence. Tech Coloproctol 19:69–82CrossRefPubMedGoogle Scholar
  2. 2.
    Atallah S (2015) Transanal total mesorectal excision: full steam ahead. Tech Coloproctol 19:57–61CrossRefPubMedGoogle Scholar
  3. 3.
    Rouanet P, Mourregot A, Azar CC et al (2013) Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum 56:408–415CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia Srl 2015

Authors and Affiliations

  • S. Atallah
    • 1
    Email author
  • B. Martin-Perez
    • 1
  • J. Drake
    • 1
  • P. Stotland
    • 2
  • S. Ashamalla
    • 2
  • M. Albert
    • 1
  1. 1.Florida HospitalWinter ParkUSA
  2. 2.Sunnybrook Health Sciences Centre, University of TorontoTorontoCanada

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