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

This video demonstrates the usefulness of infrared ureteric stents during rectal or colonic resection when there is unusual dense adhesions or mass involving the lateral pelvic wall. In this case, the patient is having a rectal resection due to severe endometriosis and there were dense adhesions between the rectum, uterus and the pelvic wall. The presence of the infrared stents visible by the 3-chip camera allowed the surgeon to mobilize the rectum off the pelvic wall and the uterus without fear of damage to the ureter, which was close by but well outlined.

The authors demonstrate how to perform a transanal total mesorectal excision using the TEO® device (Karl Storz) as well as a hemorrhoid stapler in a stepwise manner.
This pure transanal approach was performed because of a suspicion of a T2 lesion on a large villous rectal tumor at 10/12 cm from the anal verge. The originality of the technique is shown with exceptional quality views during the posterior and lateral mobilization of the root of the sigmoid mesocolon. A mechanical side-to-end pure transanal coloanal anastomosis is also perfectly shown.

The objective of this film is to demonstrate the advantage of using the new revolving handle Ligasure Advance® device, which is, for some surgeons, more ergonomic than the first generation handle. The use of the Ligasure Advance® device proves beneficial, as it provides us with a very thin 2mm electrode, allowing for a fine dissection in the submucosal region and bipolar forceps to coagulate and seal vessels.

In this key lecture, Dr. Eric Rullier focuses on sphincter-saving approaches during laparoscopic TME.

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.

Historically, solitary fibrous tumors were thought to arise from the pleura, but solitary fibrous tumors arising from extrathoracic sites have been reported in increasing frequency. This is the case of a 32-year-old woman presenting with unspecific discomfort. An 8cm-diameter round tumor situated just posterior to the middle third of the rectal ampulla is diagnosed. The laparoscopic approach is demonstrated.

Appropriate lymphatic assessment is a cornerstone of definitive surgical resection for colorectal cancer. Near-infrared (NIR) laparoscopy may allow real-time intraoperative identification of territorial lymphatic drainage and sentinel nodes in patients with early-stage disease prior to radical basin resection. In this lecture, Dr. Ronan Cahill presents this technique.

Laparoscopic surgery is widely performed. It is crucial to have a perfect knowledge of all devices and adopt the correct operative strategy. In this video presentation, Dr. Cecilia Ponzano presents some unexpected intraoperative complications along with their management.