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

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.

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.

Total mesorectal excision (TME) offers the lowest reported rates of local recurrence and the best survival results in patients with rectal cancer. This video shows a laparoscopic TME 10 weeks after radiochemotherapy for T3N+ rectal cancer.

Background: Nowadays, rectal preservation has gained popularity when it comes to the management of degenerated rectal polyps or early rectal cancer (1, 2). Tis/T1 rectal lesions can be safely treated without chemoradiation (3). Treatment via transanal minimally invasive surgery (TAMIS) offers more advantages than endoscopic submucosal dissection (ESD) (4). The authors report the case of a 60-year-old woman who underwent a TAMIS procedure for a large polyp located anteriorly in the middle rectum, which was 7cm away from the pectineal line and staged as uTisN0M0 preoperatively.
Video: The patient was placed in a prone position with a split-leg kneeling position. A reusable transanal D-Port (Karl Storz Endoskope, Tuttlingen, Germany) was introduced into the anus together with DAPRI monocurved instruments (Figure 1). The polyp was put in evidence (Figure 2) and resection margins were defined circumferentially using the monocurved coagulating hook. A full-thickness resection was performed with a complete removal of the rectal serosa and exposure of the peritoneal cavity, due to the anatomical polyp positioning (Figure 3). The rectal opening was subsequently closed using two converging full-thickness running sutures using 3/0 V-loc™ sutures (Figure 4a). The two sutures were started laterally and joined together medially (Figure 4b).
Results: Total operative time was 60 minutes whereas suturing time was 35 minutes. There was no perioperative bleeding. The postoperative course was uneventful, and the patient was discharged after 2 days. The pathological report showed a tubular adenoma with high-grade dysplasia and clear margins.
Conclusions: In the presence of degenerated rectal polyps, full-thickness TAMIS is oncologically safe and feasible. The final rectal flap can be safely closed by means of laparoscopic endoluminal sutures.

This detailed video demonstrates Dr. Joel Leroy performing a high anterior resection for a T2 rectal cancer. The surgery commences in the usual fashion with a high ligation of the inferior mesenteric artery, followed by excision of the rectum including the total mesorectal package. All the steps are presented clearly, including the vascular dissection, lateral colonic mobilisation and the laparoscopic approach for total mesorectal excision (TME).

Transanal TME for rectal cancer is a new developing surgical approach. Anatomical aspects of the procedure are presented and discussed.

In recent years, local treatment procedures have been developed to manage benign lesions of the rectum. This is the case of a superficial tumor of the anal margin located at the lower third of the rectum on its right anterior aspect. The objective of the video is to demonstrate a submucosal resection technique with the Ligasure Advance® device and using the TEO™ system manufactured by Karl Storz.