Transanal total mesorectal excision (TaTME) using flexible endoscope with laparoscopic assistance: a pilot study in porc
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ORIGINAL ARTICLE
Transanal total mesorectal excision (TaTME) using flexible endoscope with laparoscopic assistance: a pilot study in porcine models Tao Sun1 · Zhen Cao2 · Yan Zhang2 · Bairong Li1 · Yun Huang2 · Guijun Zou2 · Xin Yin1 · Xinpu Yuan2 · Chaojun Zhang2 · Shoubin Ning1 Received: 25 November 2019 / Accepted: 11 April 2020 © Italian Society of Surgery (SIC) 2020
Abstract Background Transanal total mesorectal excision (TaTME) is routinely performed to excise low rectal tumors. TaTME often relies on transanal endoscopic microsurgery (TEM) or transanal minimally invasive surgery (TAMIS) platform, all using rigid endoscopes. Our study reported a novel approach to TaTME which was completed using flexible endoscope, and we named it F-TaTME. Methods The feasibility of rectum resection using F-TaTME was evaluated in five pigs. Firstly, the superior rectal artery and vein were managed under the assistance of laparoscopy. Secondly, the flexible endoscope was used to complete the fullthickness rectotomy and rectal mobilization. Finally, the specimen was removed and the manual colon–rectal anastomosis was performed under direct vision. Results F-TaTME was accomplished in all 5 pigs. The mean procedure time was 136.6 min (97–162 min). The mean length from the lower edge of the lesion to circumferential dissection line was 1.4 cm (1.0–1.8 cm) and mean length of exteriorized rectum was 12.6 cm (11–14 cm). No injury to colorectal wall, adjacent pelvic or abdominal organs was found. Conclusions Our preliminary data suggested that F-TaTME may be a feasible method for TaTME. Keywords Transanal total mesorectal excision · Nature orifice translumenal endoscopic surgery · Flexible endoscope · Laparoscope · Animal model
Introduction Anal sphincter preservation for low rectal cancer has been an important research topic in colorectal surgery for a long time. The difficulty is how to balance the contradiction between radical resection and protection of anal function. Total mesorectal excision (TME) proposed by Heald Tao Sun and Zhen Cao are co-first authors and contributed equally to this work. * Chaojun Zhang [email protected] * Shoubin Ning shoubin‑[email protected] 1
Department of Gastroenterology, Air Force Medical Center PLA, Fucheng Road 30, Beijing 100142, China
Department of General Surgery, The 6th Medical Center, Chinese PLA General Hospital, Fucheng Road 6, Beijing 100048, China
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is considered the gold standard for mid-low rectal cancer surgery [1]. However, TME is challenging for some low rectal cancer patients with bulky tumors, obesity, or pelvic stenosis, the surgical field exposure is limited and the lower margin of the tumor is difficult to determine [2, 3]. Because of this, a new "down-to-up" surgical procedure named transanal total mesorectal excision (TaTME) has emerged [4, 5]. Compared with transabdominal laparotomic or laparoscopic TME, TaTME utilizes the transanal platforms to excise low rectal tumors by transanal alone or transanal combined with transabdominal route [6]. TaTME often relies on t
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