Transanal Endoluminal Total Mesorectal Resection (TETMR) by Transanal Endoscopic Microsurgery (TEM)
On the basis of the experience achieved with ELRR the authors have developed a technique to perform transanally the TME utilizing modified-TEM instrumentations. To perform this operation the shape of the 12 cm rectoscope has been cut with a vertical section and the rectoscope becomes significantly shorter, the “working insert” has been modified to introduce a standard laparoscope locking it. Surgery starts with a mucosal transverse circular incision at 1 cm from the lower margin of the neoplasia. A full-thickness incision is performed by electrocautery down to reach the “Holy plane” described by Heald. The smooth dissection is facilitated by the CO2 insufflation that cranially pushing back the rectal stump. Dissection continues to the peritoneal reflection. From October 2008 eight patients (5 males and 3 females) with ultralow rectal cancer underwent to TETMR. All patients underwent a long course of neoadjuvant Radiochemoterapy (nRCT) and were enrolled in a 3 months program of close follow up with an imaging and clinical check planning. At present only one patient died of cardiac disease. All others are disease free.
In our opinion TETMR represents a remarkable innovation in the treatment of RC is a feasible operation for surgeons expert in TEM procedures and it is possible that, for the advantages that it offers, it will become in a few years the most chosen operation to treat low/ultralow RC.
KeywordsTotal Mesorectal Excision Transanal Endoscopic Microsurgery Transanal Approach Rectal Stump Laparoscopic Total Mesorectal Excision
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