Endoluminal surgery, Transanal Endoscopic Microsurgery (TEM): resection of a rectal sessile polyp

Transanal Endoscopic Microsurgery (TEM) allows local excision of rectal tumors located 4 to 18cm above the anal verge. The technique is not yet generally established because of the necessary special instrumentation and tools, the unusual technical aspects of the approach, and the stringent patient selection criteria. In this lecture, N. Demartines provides us with a videoclip demonstration, and goes over the current status of TEM and addresses questions with regards to future applications.

This video demonstrates the minimally invasive approach to total mesorectal excision (TME). In this video, J. Marks, MD performs a proctectomy for low rectal cancer using the laparoscopic approach. The surgery is divided into 9 steps which are presented in detail. The entire operation is performed using conventional laparoscopic techniques. With the benefit of his extensive experience, Dr Marks provides some tips and tricks for successful laparoscopic TME.

The transanal approach for early stage rectal cancer has been well established but some complications can sometimes occur. In this lecture, Dr. Whiteford demonstrates the complications related to this technique.

Following Piercarlo Meinero’s original ideas to treat pilonidal sinus using the video-assisted anal fistula treatment (VAAFT) platform which he developed, we successfully performed this approach. This video shows different technical key points, which are essential to manage such chronic fistulas.

Total mesorectal excision (TME) has been established as a standardized radical surgical procedure in malignant tumors of the middle and lower rectal third. The objectives of TME are low rates of locoregional recurrences and good functional results. Total mesorectal excision in the radical surgical treatment of lower and middle third rectal carcinomas is the essential part of lymphatic dissection in these tumors. This film shows the low rectal dissection performed by a very experienced surgeon in a female patient presenting with cancer of the middle third of the rectum. Thanks to an adequate traction and counter-traction and thanks to the use of scissors (roticulator endo minishears), the rectum surrounded by its fascia propria is progressively divided.

This video demonstrates the transanal endoscopic microsurgery (TEM) approach to remove a large recto-sigmoid polyp. The polyp is dissected in the submucosal plane with the needle-point diathermy. Perforation of the intestinal wall occurs during resection. The technique of suture closure of the defect is described.

In this lecture, Professor Junji Okuda outlines the indications and tricks of intersphinteric resection (ISR) for low rectal tumors referring to his personal experience.

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.

Recently, some authors propose to use mini trocars to perform laparoscopic cholecystectomy while other authors recommend the use of the single port approach.
The objective of this lecture is to explore the potentialities and the rationale of these two concepts and techniques.