Current status of trans‐anal total mesorectal excision (Ta<scp>TME</scp>) following the Second International Consensus Conference

Motson, R. W.; Whiteford, Mark H.; Hompes, Roel; Albert, Matthew; Miles, W. F. A.

doi:10.1111/codi.13131

Cited by 83 publications

(68 citation statements)

References 18 publications

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“…These facts may represent the justification for the outstanding enthusiasm on TATME within the worldwide surgical community (50). The overall nature of the experience with the TATME technique is preliminary.…”

Section: Minimally Invasive Therapy and Allied Technologiesmentioning

confidence: 99%

Laparo-endoscopic Transanal Total Mesorectal Excision (TATME): evidence of a novel technique

Araújo

Perez²,

Seid

et al. 2016

Minimally Invasive Therapy & Allied Technologies

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Current available evidence regarding transanal total mesorectal excision (TATME) was analyzed including perioperative and immediate oncologic outcomes. A literature search of PubMed, Embase and Cochrane was performed. Thirty-two studies were identified, reporting on 721 patients who underwent TATME. TATME represents a feasible and reproducible technique. Nevertheless, the results of the present review are limited by the design of the included studies, which are mostly case reports and case series. Little is known about long-term oncologic outcomes, intestinal, sexual, urinary function and quality of life after TATME. Multicenter large sample randomized controlled trials are required for further investigation of these issues.

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Section: Minimally Invasive Therapy and Allied Technologiesmentioning

confidence: 99%

Laparo-endoscopic Transanal Total Mesorectal Excision (TATME): evidence of a novel technique

Araújo

Perez²,

Seid

et al. 2016

Minimally Invasive Therapy & Allied Technologies

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“…[12345] The operation has been most often described via a transanal approach (transanal minimally invasive surgery) to assist with laparoscopic total or partial mesorectal excision (TME or PME) in patients undergoing low anterior resection with sphincter preservation for cancer to enable improved circumferential margin clearance, most especially in those with a narrow pelvis. Aside from simple demonstration of feasibility, considerable endeavour continues to be spent in the standardisation of this approach's practice and dissemination to ensure the highest quality in this innovation's implementation into clinical practice so that the procedure can become a true, broadly applicable step-advance in care for our patients.…”

Section: Introductionmentioning

confidence: 99%

Abdomino-endoscopic perineal excision of the rectum for benign and malignant pathology: Technique considerations for true transperineal verus transanal total mesorectal excision endoscopic proctectomy

Furajii

Kennedy

2017

J Min Access Surg

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PURPOSE:Transanal minimally invasive surgery using single port instrumentation is now well described for the performance of total mesorectal excision with restorative colorectal/anal anastomosis most-often in conjunction with transabdominal multiport assistance. While non-restorative abdomino-endoscopic perineal excision of the anorectum is conceptually similar, it has been less detailed in the literature.METHODS:Consecutive patients undergoing non-restorative ano-proctectomy including a transperineal endoscopic component were analysed. All cases commenced laparoscopically with initial medial to lateral mobilisation of any left colon and upper rectum. The lower anorectal dissection started via an intersphincteric or extrasphincteric incision for benign and malignant pathology, respectively, and following suture closure and circumferential mobilisation of the anorectum, a single port (GelPOINT Path, Applied Medical) was positioned allowing the procedure progress endoscopically in all quadrants up to the cephalad dissection level. Standard laparoscopic instrumentation was used. Specimens were removed perineally.RESULTS:Of the 13 patients (median age 55 years, median BMI 28.75 kg/m2, median follow-up 17 months, 6 males), ten needed completion proctectomy for ulcerative colitis following prior total colectomy (three with concomitant parastomal hernia repair) while three required abdominoperineal resection for locally advanced rectal cancer following neoadjuvant chemoradiotherapy. Median operative time was 190 min, median post-operative discharge day was 7. Eleven specimens were of high quality. Four patients developed perineal wound complications (one chronic sinus, two abscesses needing drainage) within median 17-month follow-up.CONCLUSION:Convergence of transabdominal and transanal technology and technique allows accuracy in combination operative performance. Nuanced appreciation of transperineal operative access should allow specified standardisation and innovation.

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“…This may lead to iatrogenic nerve damage and jeopardize adequate oncological clearance. TME performed via transanal access platforms could have particular advantages with regard to radical surgery and functional preservation, especially in those patients with the above-mentioned confounding factors [3,4]. The combination with the electrophysiological detection of visually unrecognized nervous tissue may serve as an improved guidance for the nerve-sparing technique [5].…”

Section: Introductionmentioning

confidence: 99%

Surface Electromyography Reliably Records Electrophysiologically Evoked Internal Anal Sphincter Activity: A More Minimally Invasive Approach for Monitoring Extrinsic Innervation

Kauff

Wachter²,

Heimann³

et al. 2016

Eur Surg Res

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Background: Even in the case of minimally invasive pelvic surgery, sparing of the autonomic nerve supply is a prerequisite for maintaining anal sphincter function. Internal anal sphincter (IAS) innervation could be electrophysiologically identified based on processed electromyographic (EMG) recordings with conventional bipolar needle electrodes (NE). This experimental study aimed for the development of a minimally invasive approach via intra-anal surface EMG for recordings of evoked IAS activity. Methods: Six male pigs underwent nerve-sparing low anterior rectal resection. Electric autonomic nerve stimulations were performed under online-processed EMG of the IAS. EMG recordings were simultaneously carried out with conventional bipolar NE as the reference method and newly developed intra-anal surface electrodes (SE) in different designs. Results: In all experiments, the IAS activity could be continuously visualized via EMG recordings based on NE and SE. The median number of bipolar electric stimulations per animal was 27 (range 5-52). The neurostimulations resulted in significant EMG amplitude increases for both recording types [NE: median 3.0 µV (interquartile range, IQR 2.8-3.5) before stimulation vs. 7.1 µV (IQR 3.9-13.8) during stimulation, p < 0.001; SE: median 3.6 µV (IQR 3.1-4.3) before stimulation vs. 6.8 µV (IQR 4.8-10.3) during stimulation, p < 0.001]. Conclusions: Intra-anal SE enabled reliable EMG of electrophysiologically evoked IAS activity similar to the conventional recording via NE. The transfer of the method to access platforms for transanal total mesorectal excision or robotics may offer a practical more minimally invasive approach for monitoring extrinsic innervation.

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Current status of trans‐anal total mesorectal excision (TaTME) following the Second International Consensus Conference

Cited by 83 publications

References 18 publications

Laparo-endoscopic Transanal Total Mesorectal Excision (TATME): evidence of a novel technique

Laparo-endoscopic Transanal Total Mesorectal Excision (TATME): evidence of a novel technique

Abdomino-endoscopic perineal excision of the rectum for benign and malignant pathology: Technique considerations for true transperineal verus transanal total mesorectal excision endoscopic proctectomy

Surface Electromyography Reliably Records Electrophysiologically Evoked Internal Anal Sphincter Activity: A More Minimally Invasive Approach for Monitoring Extrinsic Innervation

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