Shinichiro Mori, MD, PhD, Yoshiaki Kita, MD, PhD, Kan Tanabe, MD, PhD, Kenji Baba, MD, PhD, Masayuki Yanagi, MD, Takaaki Arigami, MD, PhD, Hiroshi Kurahara, Masahiko Sakoda, MD, PhD, Yasuto Uchikado, MD, PhD, Kosei Maemura, MD, PhD, Yuko Mataki, MD, PhD, Shoji Natsugoe, MD, PhD. Department of Digestive Surgery, Breast and Thyroid Surgery Graduate School of Medicine, Kagoshima University
Objective: The aim of this study was to assess safety and feasibility of total mesorectum excision (TME) within the holy plane based on embryology for rectal cancer.
Methods: Prospectively collected data of 36 consecutive patients with rectal cancer who underwent TaTME from November 2014 to August 2017 were enrolled. Surgical outcomes including TME completeness, operative time for TME completion, blood loss, complications, pathological findings and length of hospital stay were assessed.
Surgical procedure: After performing ractal lavage, self-retaining anal retractor was set, and anal dilators were used for an atraumatic introduction of the transanal access devise (GelPOINT path). Three of 10-mm trocars and one of 15-mm trocar were inserted through the GelPOINT path in a quadrant shape. Then the GelPOINT path was introduced through the anal to rectum. After rectosigmoid colon was temporally clamped using an atraumatic endo bulldog clip, pneumoperitoneum was maintained at 15 mmHg with carbon dioxide via an Air Seal platform. A purse-string suture using a 0 polypropylen with 26-mm rounded needle was performed clock-wise to tightly occlude the rectum with a 3 cm margin distal to the tumor. After irrigation with saline and marking dissection line with tattooing the rectal mucosa distal to the mucosal folds, a mucosal transection of rectum was initiated. Then a full-thickness rectal transection was performed circumferentially. After dissection of rectococcygeal muscle at 6 o’clock and rectourethral muscle in the anterior wall, circumferential sharp dissection within the holy plane was performed. Dissection proceeded between the endopelvic fascia and the prehypogastric nerve fascia in the posterior plane, between the Denonvilliers’s fascia and the anterior mesorectum in the anterior plane, and between pelvic nerve and the mesorectum with recognition of the neurovascular bandle in the lateral plane. Then the dissection connected to the abdominal plane via laparoscopic team with working together until TME completed.
Results: TME completion performed in 34 (94.4%) patients. Thirty five (97.2%) patients had negative of circumferential resection margin. Mean of TME completion time and blood loss were 146 min and 72 g, respectively. One (2.8%) patient had an intraoperative complication and 7 (19.4%) patients had postoperative complications. No other complications occurred. The length of hospital stay was 12 days.
Conclusions: TaTME within the holy plane on based on embryology is a safe and feasible procedure for rectal cancer.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87175
Program Number: P288
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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