Shinichiro Imai, Masaaki Ito, Nobuyoshi Takeshita, Koji Ikeda, Yuichiro Tsukada, Yuji Nishizawa, Takeshi Sasaki. National Cancer Center East, Department of Colorectal surgery
Background: Transanal total mesorectal excision (TaTME) for rectal cancer is gaining in popularity among colorectal surgeons in Japan. This procedure carries the advantages of good visualization in the narrow pelvic cavity and ease of linear manipulation, which is especially useful for male and obese patients, and particularly for lower and bulky rectal tumors. TaTME has also been shown to confer oncological benefits. Despite these benefits, even though TaTME requires specific training because it involves unusual anatomical recognition and intricate technique, no TaTME structural training model or simulator had been developed until recently.
Development: In cooperation with a medical simulator manufacturer, we have developed a TaTME simulator, which was constructed using a 3D printer with components modeled after computed tomography images. This model simulates the rectum and surrounding structures, such as the rectourethral muscles,Denonvilliers’ fascia,the rectococcygeal muscle,and adjacent neurovascular bundles. The simulator allows us to perform mock transanal surgery while visualizing these structures in the model, allowing the Step-by-Step learning of each TaTME step: marking and purse-string suturing, rectal wall incision,posterior dissection I,anterior dissection,posterior dissection II,lateral dissection, dissection of neurovascular bundles,rendez-vous procedure,and coloanal anastomosis. Since last year, we have held regular TaTME seminars, which include hands-on demonstrations of this simulator, and over 100 participants have taken part.
In the curriculum for TaTME, proficiency is achieved in stages: Stage I, self-learning; Stage II, cadaver workshop; Stage III, proctorship; Stage IV, independent practice. However, in Japan, there are limited opportunities for cadaveric training. Our simulator is expected to be used as a new tool to facilitate Stage I and Stage II of the TaTME training process.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 98798
Program Number: ETP751
Presentation Session: Emerging Technology Poster Session (Non CME)
Presentation Type: Poster