Live interactive transanal TME (TaTME) with the TEO™ platform

The objective of this film is to demonstrate how to perform a laparoscopic redo of a recurrence after carrying out a low colorectal anastomosis through open surgery to manage a cancer of the mid-upper rectum following radiochemotherapy.

In this lecture, Dr. Robin Kennedy presents his experience in performing laparoscopic colorectal cancer surgery with the intent to determine the potential for laparoscopic resection and its applicability in this setting. In addition, conversions are analysed in order to define which cases might be avoided at different stages in a surgeon's experience. With experience, laparoscopic surgery is feasible in around 90 percent of elective colorectal cancer resections.

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.

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.

In this key lecture, Dr. Charles Bailey focuses on rectal anatomy.

This is the case of a 48-year-old man who presented with rectal bleeding. A cT3N1 adenocarcinoma was diagnosed in the middle/high rectum. This video demonstrated the intraoperative use of a 3D model. Preoperatively, a 3D model was extracted from medical imaging (CT-scan) by experts in medical image analysis. The technique of laparoscopic robot-assisted low anterior resection is described in a stepwise manner.

Total mesorectal excision (TME) is the gold standard in the treatment of rectal cancer. Some technical details are essential when using the laparoscopic approach. In this key lecture, Prof. Leroy provides some tips and tricks.