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Laparoscopic total mesorectal excision (TME) through single right iliac fossa (RIF) incision
Background: Single incision laparoscopy is worth of interest during up-to-down rectal resection because it allows to use the single site as the site of temporary ileostomy placement at the end of the procedure.
Video: This video shows an up-to-down single incision laparoscopic rectal resection in a 49-year-old woman presenting with a rectal adenocarcinoma located 12cm away from the anal margin. Preoperative work-up showed a T2N0M0 tumor. The procedure was entirely performed with curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany), inserted in the right flank. The uterus and the peritoneal sheet covering the vagina were retrieved using percutaneous sutures. A circular mechanical colorectal anastomosis was performed and a final temporary ileostomy was placed at the site of the single access.
Results: The procedure duration was 297 minutes, and peroperative bleeding was unsignificant. The final scar length was 2.5cm, and the patient was discharged on postoperative day 5. The pathological report confirmed a pT2N0M0 tumor (20 negative nodes).
Conclusions: Up-to-down single incision laparoscopic rectal resection allows to place the temporary ileostomy at the single incision site, offering oncological results comparable to conventional laparoscopy.
G Dapri, N Bachir, L Antolino, K Grozdev, D Guta, K Jottard, GB Cadière
Surgical intervention
3 years ago
2275 views
108 likes
0 comments
09:22
Laparoscopic total mesorectal excision (TME) through single right iliac fossa (RIF) incision
Background: Single incision laparoscopy is worth of interest during up-to-down rectal resection because it allows to use the single site as the site of temporary ileostomy placement at the end of the procedure.
Video: This video shows an up-to-down single incision laparoscopic rectal resection in a 49-year-old woman presenting with a rectal adenocarcinoma located 12cm away from the anal margin. Preoperative work-up showed a T2N0M0 tumor. The procedure was entirely performed with curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany), inserted in the right flank. The uterus and the peritoneal sheet covering the vagina were retrieved using percutaneous sutures. A circular mechanical colorectal anastomosis was performed and a final temporary ileostomy was placed at the site of the single access.
Results: The procedure duration was 297 minutes, and peroperative bleeding was unsignificant. The final scar length was 2.5cm, and the patient was discharged on postoperative day 5. The pathological report confirmed a pT2N0M0 tumor (20 negative nodes).
Conclusions: Up-to-down single incision laparoscopic rectal resection allows to place the temporary ileostomy at the single incision site, offering oncological results comparable to conventional laparoscopy.
Transanal laparoscopic TME with a new port assisted by single incision
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.
G Dapri, L Antolino, N Bachir, D Guta, K Grozdev, B Nebbot, K Jottard, GB Cadière
Surgical intervention
4 years ago
2807 views
40 likes
0 comments
12:53
Transanal laparoscopic TME with a new port assisted by single incision
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.
PROGRESS - Transanal TME with colo-anal anastomosis without trans-abdominal assistance for rectal cancer in a male patient
The authors put forward an original oncologic Total Mesorectal Excision (TME) technique combined with distal sigmoidectomy followed by a mechanical colo-anal side-to-end anastomosis using a purely transanal route.
The originality of this technique lies in the strictly transanal approach without any laparoscopic assistance as well as in the oncologic dissection of the rectum around its fascia propria. In addition, the technique is outstanding in the mobilization of the sigmoid mesocolon’s root as well as in the retroperitoneal mobilization of the vascular inferior mesenteric axis, hence avoiding contact with intra-abdominal organs.
This technique is called PROGRESS (Peri Rectal Oncologic Gateway for Retroperitoneal EndoScopic Surgery) due to the retroperitoneal endoscopic dissection using a perirectal access.
The video shows images of remarkable quality, especially of anatomical nerve structures, due to the use of a 4mm, 30-degree scope and a Karl Storz High-Definition camera introduced through the TEO™ device.
J Leroy, D Ntourakis, J Marescaux
Surgical intervention
6 years ago
5945 views
34 likes
0 comments
18:55
PROGRESS - Transanal TME with colo-anal anastomosis without trans-abdominal assistance for rectal cancer in a male patient
The authors put forward an original oncologic Total Mesorectal Excision (TME) technique combined with distal sigmoidectomy followed by a mechanical colo-anal side-to-end anastomosis using a purely transanal route.
The originality of this technique lies in the strictly transanal approach without any laparoscopic assistance as well as in the oncologic dissection of the rectum around its fascia propria. In addition, the technique is outstanding in the mobilization of the sigmoid mesocolon’s root as well as in the retroperitoneal mobilization of the vascular inferior mesenteric axis, hence avoiding contact with intra-abdominal organs.
This technique is called PROGRESS (Peri Rectal Oncologic Gateway for Retroperitoneal EndoScopic Surgery) due to the retroperitoneal endoscopic dissection using a perirectal access.
The video shows images of remarkable quality, especially of anatomical nerve structures, due to the use of a 4mm, 30-degree scope and a Karl Storz High-Definition camera introduced through the TEO™ device.
Robotic total mesorectal excision, a practical solution in an obese female patient
This video describes a practical solution to total mesorectal excision using robotics. The patient is a 55-year-old female with a BMI of 32 and low rectal cancer localized 3cm above the anorectal ring. She also has large uterine fibroids.
The patient received preoperative chemoradiation and subsequently underwent a surgical procedure in form of ultra low anterior resection with colonic J pouch creation and protective ileostomy.
The concept of the procedure utilizes several surgical techniques which seem to be best suited for an obese patient with locally advanced low rectal cancer. The main emphasis during this presentation is placed on robotic total mesorectal excision. On the other hand, we would like to present a fairly universal approach to any low rectal cancer.
Several important issues in regards to the current robotic technology are discussed. These include the obvious advantage in the deep pelvis, hybrid concept, and the answer to the question “Why isn’t the entire procedure performed robotically?”
S Marecik, M Zawadzki, C Corning, J Park, L Prasad
Surgical intervention
8 years ago
3634 views
26 likes
0 comments
15:28
Robotic total mesorectal excision, a practical solution in an obese female patient
This video describes a practical solution to total mesorectal excision using robotics. The patient is a 55-year-old female with a BMI of 32 and low rectal cancer localized 3cm above the anorectal ring. She also has large uterine fibroids.
The patient received preoperative chemoradiation and subsequently underwent a surgical procedure in form of ultra low anterior resection with colonic J pouch creation and protective ileostomy.
The concept of the procedure utilizes several surgical techniques which seem to be best suited for an obese patient with locally advanced low rectal cancer. The main emphasis during this presentation is placed on robotic total mesorectal excision. On the other hand, we would like to present a fairly universal approach to any low rectal cancer.
Several important issues in regards to the current robotic technology are discussed. These include the obvious advantage in the deep pelvis, hybrid concept, and the answer to the question “Why isn’t the entire procedure performed robotically?”
Autonomic nerve-preserving laparoscopic total mesorectal excision in a male patient based on a new anatomical concept
Dr. Kinugasa proposed the new concept of surgical anatomy in the pelvis. In his concept, the pre-hypogastric nerve fascia is defined as a fibrous membrane, which covers the superior hypogastric nerve plexus, the hypogastric nerves and the pelvic nerve plexus. In this video, we present our procedure of laparoscopic Total Mesorectal Excision (TME) in a male patient, focusing on the relationship of the hypogastric nerve fascia, the Denonvilliers’ fascia and the nervous system in the pelvis. The technical characteristics of this procedure are as follows: sharp dissection with electrocautery through the entire procedure, posterior and lateral dissection along the pre-hypogastric nerve fascia, anterior dissection behind the Denonvilliers’ fascia (DVF), and unroofing of neurovascular bundles by the assistant in order to recognize and dissect the lowest part of the mesorectum in the antero-lateral corner of the pelvis.
Y Sakai, K Hida, K Kawada, JI Kawamura, A Nomura, S Nagayama, S Hasegawa
Surgical intervention
8 years ago
9094 views
51 likes
0 comments
14:29
Autonomic nerve-preserving laparoscopic total mesorectal excision in a male patient based on a new anatomical concept
Dr. Kinugasa proposed the new concept of surgical anatomy in the pelvis. In his concept, the pre-hypogastric nerve fascia is defined as a fibrous membrane, which covers the superior hypogastric nerve plexus, the hypogastric nerves and the pelvic nerve plexus. In this video, we present our procedure of laparoscopic Total Mesorectal Excision (TME) in a male patient, focusing on the relationship of the hypogastric nerve fascia, the Denonvilliers’ fascia and the nervous system in the pelvis. The technical characteristics of this procedure are as follows: sharp dissection with electrocautery through the entire procedure, posterior and lateral dissection along the pre-hypogastric nerve fascia, anterior dissection behind the Denonvilliers’ fascia (DVF), and unroofing of neurovascular bundles by the assistant in order to recognize and dissect the lowest part of the mesorectum in the antero-lateral corner of the pelvis.