• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / The New Videoscopic Method of Presacral Space Exploration Allowing Removal of the Mesorectum Combined with Idenetification of the Innervation Using Cavermap Device

The New Videoscopic Method of Presacral Space Exploration Allowing Removal of the Mesorectum Combined with Idenetification of the Innervation Using Cavermap Device

Piotr Walega, MD PhD, Jakob Kenig, MD, Piotr Richter, Prof, Wojciech Nowak, Prof. Jagiellonian University Collegium Medicum

At present, local excision using TEM is accepted method of operation of T1 rectal cancer. However, it is connected with 7-10% risk of metastases in the regional lymph nodes. Endoscopic posterior mesorectal excision, firstly described by Zerz et al., allows removing mesorectum. We performed 9 of this kind of operations. In the follow-up, in one male case we observed sexual dysfunction, which was probably connected with the damage of the innervation. After detailed analysis of small pelvis innervations on the cadavers we are going to introduce TEM + EPMR with apply of CAVEMAP monitor. The goal of the project is minimal invasive removal of the tumor with lymph nodes with simultaneous assessment and protection of the innervations. Firstly, the surgical task is performed using TEO equipment (Storz, Germany) with an operative rectoscope 4 cm in diameter and 20 cm long, through which special surgical tools can be inserted. The patient is positioned so that the tumor is localized downwards in the operating field according to preoperative sigmoideoscopy. The operating technique is performed as described by Buess. As in the second stage, EPMR is performed four to six weeks after the former operation. The procedure is performed as described by Zerz et al. Patients under general anesthesia are placed in the prone jackknife position. A typical laparoscopic unit with 30-degree 10-mm optics are used. Through a perineal 10-mm incision, the pelvic floor is penetrated between the anus and the tip of the coccyx by blunt dissection. Using the index finger, the retrorectal space is dilated, so that a distention balloon system (PDB 1000i, Autosuturei, Tyco Healthcare, Wollerau, Switzerland) can be inserted. Under video-assistance the system is distended to create a sufficiently large operating space. Then the balloon is replaced by a 10-mm trocar and a 12 mmHg pneumoextraperitoneum was established. Two additional 5-mm trocars were placed to the left and the right of the coccyx. The retrorectal space was further distended bluntly up to the level of the sacral promontory. Using ultrasound scissors the perirectal fascia was incised in the lowest area and the posterior part of the mesorectum was dissected from the posterior wall of the rectum also up to the sacral promontory, where the superior rectal artery was clipped and cut. The resected tissue was finally removed in latex protection bags and a suction drainage was applied to the sacral cavity. EPMR with apply of Cavermap device: Preoperatively, an electrode is placed on the penis monitoring changes in volume of the cavernosus body. Using an electrode, introduced through a working channel, nerves of the pelvis plexus are identified. A nerve sparing mesorectum excision is done up to the level of the rectalis superior artery. The goal of this technique is firstly a protection of the innervations of the pelvis minor during local excisions of the rectal cancer combined with excision of the mesorectum. The next step will be introduction of the COVERMAP device for the diagnostic of the obstipation.


Session: Emerging Technology Poster
Program Number: ETP104
View Poster

265

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals