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Techniques in Coloproctology

, Volume 21, Issue 3, pp 233–235 | Cite as

Combined transanal total mesorectal excision (taTME) with laparoscopic instruments and abdominal robotic surgery in rectal cancer

  • R. BravoEmail author
  • J.-S. Trépanier
  • M. C. Arroyave
  • M. Fernández-Hevia
  • A. Pigazzi
  • A. M. Lacy
Multimedia Article

Abstract

Laparoscopic surgery for rectal cancer can be technically challenging. We describe a hybrid technique combining abdominal robotic dissection and transanal total mesorectal excision. This procedure was performed in a 50-year-old man with rectal adenocarcinoma at 5 cm from the dentate lane. Preoperative staging was T2N0M0. Surgery went well without complications, and estimated blood loss was less than 50 mL. Robotic surgical time was 90 min, and total operative time was 160 min. The patient was discharged on postoperative day 3. Pathology analysis revealed an intact mesorectum (TME grade 3) and a T2N0 tumor with negative margins. Hybrid surgery with pelvic robotic dissection and transanal total mesorectal excision was feasible, quick and safe in this patient and may be a method that can be developed further.

Keywords

Robotic surgery Transanal total mesorectal excision Transanal TME Rectal cancer Laparoscopy 

Notes

Acknowledgements

We would like to thank AIS Channel (aischannel.com) for the streaming of the attached video.

Compliance with ethical standards

Conflict of interest

Raquel Bravo, Jean-Sébastien Trépanier, Maria Clara Arroyave and A.M. Lacy have no conflict of interest to disclose. María Fernandez-Hevia has received a grant from Covidien and from the private research foundation Cellex in the last 2 years. Alessio Pigazzi has been a consultant for Intuitive Surgical, Cook, Ethicon, Covidien, Cubist.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.

Supplementary material

Supplementary material 1 (MP4 199823 kb)

References

  1. 1.
    Pigazzi A, Luca F, Patriti A, Valvo M, Ceccarelli G, Casciola L, Biffi R, Garcia-Aguilar J, Baek J-H (2010) Multicentric study on robotic tumor-specific mesorectal excision for the treatment of rectal cancer. Ann Surg Oncol 17:1614–1620CrossRefPubMedGoogle Scholar
  2. 2.
    Baek SK, Carmichael JC, Pigazzi A (2013) Robotic surgery: colon and rectum. Cancer J 19:140–146CrossRefPubMedGoogle Scholar
  3. 3.
    Melich G, Hong YK, Kim J, Hur H, Baik SH, Kim NK, Sender Liberman A, Min BS (2015) Simultaneous development of laparoscopy and robotics provides acceptable perioperative outcomes and shows robotics to have a faster learning curve and to be overall faster in rectal cancer surgery: analysis of novice MIS surgeon learning curves. Surg Endosc 29:558–568CrossRefPubMedGoogle Scholar
  4. 4.
    Heald RJ (2013) A new solution to some old problems: transanal TME. Tech Coloproctol 17:257–258CrossRefPubMedGoogle Scholar
  5. 5.
    Rouanet P, Mourregot A, Azar CC, Carrere S, Gutowski M, Quenet F, Saint-Aubert B, Colombo P-E (2013) Transanal endoscopic proctectomy. Dis Colon Rectum 56:408–415CrossRefPubMedGoogle Scholar
  6. 6.
    Velthuis S, Nieuwenhuis DH, Ruijter TEG, Cuesta MA, Bonjer HJ, Sietses C (2014) Transanal versus traditional laparoscopic total mesorectal excision for rectal carcinoma. Surg Endosc 28:3494–3499CrossRefPubMedGoogle Scholar
  7. 7.
    Atallah S, Martin-Perez B, Albert M, deBeche-Adams T, Nassif G, Hunter L, Larach S (2014) Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): results and experience with the first 20 patients undergoing curative-intent rectal cancer surgery at a single institution. Tech Coloproctol 18:473–480CrossRefPubMedGoogle Scholar
  8. 8.
    Lacy AM, Tasende MM, Delgado S, Fernández-Hevia M, Jimenez M, De Lacy B, Castells A, Bravo R, Wexner SD, Heald RJ (2015) Transanal total mesorectal excision for rectal cancer: outcomes after 140 patients. J Am Coll Surg 221:415–423CrossRefPubMedGoogle Scholar
  9. 9.
    Fernández-Hevia M, Delgado S, Castells A, Tasende M, Momblan D, Díaz del Gobbo G, DeLacy B, Balust J, Lacy AM (2015) Transanal total mesorectal excision in rectal cancer. Ann Surg 261:221–227CrossRefPubMedGoogle Scholar
  10. 10.
    Gómez Ruiz M, Parra IM, Palazuelos CM, Martín JA, Fernández CC, Diego JC, Fleitas MG (2015) Robotic-assisted laparoscopic transanal total mesorectal excision for rectal cancer: a prospective pilot study. Dis Colon Rectum 58(1):145–153. doi: 10.1097/DCR.0000000000000265 CrossRefPubMedGoogle Scholar
  11. 11.
    Colombo PE, Bertrand MM, Alline M, Boulay E, Mourregot A, Carrère S, Quénet F, Jarlier M, Rouanet P (2016) Robotic versus laparoscopic total mesorectal excision (TME) for sphincter-saving surgery: is there any difference in the transanal tme rectal approach?: A single-center series of 120 consecutive patients. Ann Surg Oncol 23(5):1594–1600. doi: 10.1245/s10434-015-5048-4 Epub 2015 Dec 29 CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • R. Bravo
    • 1
    Email author
  • J.-S. Trépanier
    • 1
    • 2
  • M. C. Arroyave
    • 1
    • 3
  • M. Fernández-Hevia
    • 1
  • A. Pigazzi
    • 4
  • A. M. Lacy
    • 1
  1. 1.Hospital Clínic de BarcelonaBarcelonaSpain
  2. 2.Hôpital Maisonneuve-RosemontMontrealCanada
  3. 3.Clínica SomerRionegroColombia
  4. 4.Irvine Medical CenterUniversity of CaliforniaOrangeUSA

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