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

The colorectal surgeon is often faced with serious postoperative complications such as fistulas and strictures. In this key lecture, Dr. Bretagnol presents the guidelines for the prevention and management of such complications.

Transanal endoscopic microsurgery (TEM) provides direct endoscopic access to the rectum and peritoneal cavity. In this lecture, Dr. Sylla presents the evolution of the TEM approach from the first reports to the present-day application of laparoscopic and NOTES approaches.

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.

Endometriosis is a complex disease involving different anatomical structures. In this key lecture, Professor Joël Leroy outlines the associated laparoscopic colorectal resection without diverting stoma.

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.

The description of the laparoscopic total mesorectal excision (TME) for cancer covers all aspects of the surgical procedure used for the management of rectal cancer.
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: exploration, exposure, vascular approach, risk of nerve damage, mobilization of sigmoid colon, mobilization of upper rectum, dissection of lower rectum, splenic flexure, division of rectosigmoid, extraction, direct anastomosis, J-shaped anastomosis.
Consequently, this operating technique is well standardized for the management of this condition.

In this key lecture, Dr. Patricia Sylla highlights the TES toolkit, stressing preparation and technical steps.

In this key lecture, Dr. Huscher briefly describes the three-port Melani technique for splenic flexture mobilization. He demonstrates trocar position as well as the main principles of gastrocolic ligament division and technical aspects of splenic flexure taking down according to the Melani technique along with a video case presentation.

This video presents a stepwise approach to perform the pelvis’ reperitonization following removal of the rectum after an abdominoperineal resection in a female patient. The surgeon uses absorbable monofilament suture material that is much easier to manipulate. Two half running sutures with an intracorporeal stitch are used for a complete reperitonization by using the genital organs, in particular the left and right broad ligaments, along with the uterus.