monthly focus

surgical intervention video

Excision totale du mésorectum par voie laparoscopique transanale avec un nouveau trocart avec incision unique


TME transanal laparoscópica com um novo portal assistido por incisão única


TME transanal laparoscópica con un nuevo puerto asistido por incisión única


Background: Rectal resection with total mesorectal excision (TME) can be performed through the anus going up into the abdominal cavity. This approach has to be performed using a transanal device in order to create a retroperitoneum, allowing the surgeon to perform a TME similar to the one performed from the abdomen going down to the anus. A new reusable port named DAPRI Port or D-Port (Karl Storz Endoskope, Tuttlingen, Germany) has been developed, and a new platform together with curved reusable instruments according to DAPRI (Karl Storz Endoskope) has been created. The D-Port allows to maintain one of the rules of laparoscopy, which is the optical system in the middle of the two ancillary operative tools. In addition, the cost of the procedure is not increased, due to the reusable material. 

Video: This video shows a down-to-up rectal resection assisted by single incision laparoscopy, in a 65-year old man presenting with a rectal adenocarcinoma 4cm away from the anal margin. Preoperative work-up showed a T2N0M0 tumor, after radiochemotherapy. The procedure was performed transabdominally for the vascular dissection and transanally for the TME. The abdominal single site was then used for the placement of the temporary ileostomy. 

Results: Total operative time was 301 minutes, and partial transanal laparoscopy was 145 minutes. Perioperative bleeding was 50cc. The final scar length was 2.5cm, and the patient was discharged after 5 days. The pathological report confirmed a pT2N0M0 tumor (15 negative nodes). 

Conclusions: Down-to-up rectal resection is an interesting procedure, and when associated with single incision laparoscopy, it offers the possibility to use the single site as the site for temporary ileostomy.

Transanal laparoscopic TME with a new port assisted by means of a single incision

经肛门腹腔镜TME与一个新的端口辅助单切口


Трансанальная лапароскопическая ТМЕ с новым троакаром единого доступа


TME para cáncer rectal: disección total del mesorrecto transanal (TMD) con asistencia laparoscópica de puerto único


TME pour cancer rectal : dissection totale du mésorectum par voie transanale et assistance laparoscopique avec trocart unique


TME para câncer retal: dissecção total do mesorreto transanal (TMD) com assistência laparoscópica de portal único


TME用于直肠癌：经肛门全直肠系膜切除（TMD），单端口腹腔镜辅助


ТМЕ при раке прямой кишки: трансанальная мобилизация мезоректума с однопортовой лапароскопической ассистенцией


This is the case of a 65-year-old man who presented with recurrent rectal bleedings. During a diagnostic colonoscopy, a rectal polyp was excised. The pathologist reported a pT1(sm2) moderately to poorly differentiated rectal adenocarcinoma with a resection margin of less than 1mm at the base of the polyp and on the lateral side without vascular invasion. A transanal TME was decided upon in a patient with severe systemic disease. It was converted into a laparoscopically assisted procedure. 

TME for rectal cancer: transanal total mesorectal dissection (TMD) with single port laparoscopic assistance

This is the case of a 58-year-old man who presented with rectal bleeding. A T4N0 middle and low rectal adenocarcinoma was diagnosed. This video demonstrates a sphincter-preserving laparoscopic ultra-low anterior resection and focusses on the technique of the transanal intersphincteric dissection and restoration of continuity by the creation of a hand-sewn colo-anal anastomosis.

Low rectal cancer: laparoscopic TME with intersphincteric resection after radiochemotherapy (RCT)

Лапароскопическая ТМЭ с интерсфинктерной резекцией прямой кишки по поводу низкоампулярного рака после химиолучевой терапии


Cáncer rectal bajo: TME laparoscópica con resección interesfincteriana después de radio y quimioterapia


Câncer retal baixo: TME laparoscópica com ressecção interesfincteriana após rádio e quimioterapia


低位直肠癌：放化疗后伴有括约肌切除术的腹腔镜TME（RCT）


Cancer du bas rectum : TME laparoscopique avec résection intersphinctérique après radiochimiothérapie


Resección abdominoperineal (RAP) laparoscópica conforme idealizada por Miles para cáncer rectal en la unión anorrectal


Лапароскопическая брюшно-промежностная экстирпация по Майлсу по поводу рака прямой кишки на уровне аноректального перехода


Ressecção abdominoperineal (RAP) laparoscópica conforme idealizada por Miles para câncer retal na junção anorretal


腹腔镜腹会阴联合切除术（APR）根据Miles在肛门直肠连接处的直肠癌


This is the case of a 55-year-old woman who presented with pelvic pain. A cT3N0 low rectal adenocarcinoma was diagnosed. This video demonstrates a laparoscopic abdominoperineal resection and focuses on the perineal extrasphincteric dissection technique. 

The authors of the video do not have any conflicts of interest or financial ties to disclose.

Laparoscopic abdominoperineal resection (APR) according to Miles for rectal cancer at the anorectal junction

Résection laparoscopique abdominopéritonéale selon Miles pour cancer rectal à la jonction anorectale


video lecture

Transanal TME for rectal cancer is a new developing surgical approach. Anatomical aspects of the procedure are presented and discussed.

Transanal anatomy

Anatomie transanale


A TME transanal para para câncer de reto é uma abordagem cirúrgica em desenvolvimento.Os aspectos anatômicos do procedimento são apresentados e discutidos.


Anatomia transanal

A TME transanal para câncer de reto pode ser realizada como um procedimento híbrido ou de modo puramente transanal.Os pontos-chave desta TaTME pura realizada através de uma plataforma TEO™ são apresentados e discutidos.


Novas abordagens na cirurgia colorretal: TME transanal pura e TaTME pura, pontos-chave da nossa técnica

Nouvelles approches en chirurgie colorectale : TME purement transanal et TaTME, points clés de notre technique


Transanal TME for rectal cancer can be performed as a hybrid procedure or in a pure transanal fashion. The key points of this pure TaTME performed through a TEO™ platform are presented and discussed.

New approaches in colorectal surgery: pure transanal TME and pure TaTME, key points of our technique

Transanal TME for rectal cancer is a new developing surgical approach. Technical aspects of the procedure performed through a TEO™ platform are presented and discussed.

Transanal NOTES: how to make it better

NOTES transanal : comment l'améliorer


A TME transanal para para câncer de reto é uma abordagem cirúrgica em desenvolvimento.Os aspectos técnicos do procedimento realizado através de uma plataforma TEO™ são apresentados e discutidos.


NOTES transanal: como torná-lo melhor

Focus sur la chirurgie rectale - TME pour cancer rectal : technique TATA et TaTME


Focus on Rectal Surgery - TME for rectal cancer: combined transabdominal and transanal techniques (TATA) and full NOTES transanal TME (TaTME) 

В центре внимания - ректальная хирургия. Тотальная мезоректумэктомия по поводу рака прямой кишки: комбинированная трансабдоминальная и трансанальная техника (ТАТА) и NOTES трансанальная тотальная ТМЕ (ТаТМЕ)
