Search results for "Mesorectal"
showing 10 items of 44 documents
Transanale totale mesorektale Exzision – Voraussetzungen zur sicheren Implementierung
2019
ZusammenfassungDie transanale totale mesorektale Exzision (TaTME) ist eine innovative und technisch anspruchsvolle Methode zur chirurgischen Behandlung des Rektumkarzinoms. Ziel dieses Artikels ist es, die Voraussetzungen und Trainingsbedingungen darzustellen, die für die sichere Implementierung dieses komplexen Verfahrens entscheidend sind. Die internationalen Expertenmeinungen werden vor dem Hintergrund der veröffentlichten Ergebnisse aus TaTME-Schulungszentren diskutiert. Darüber hinaus werden eigene Erfahrungen aus den TaTME-Anatomiekursen (Video) und einer ersten klinischen Serie von 102 TaTMEs mitgeteilt. Das Verfahren sollte in erster Linie von kolorektal spezialisierten Fachärzten f…
Robotic transanal total mesorectal excision: Is the future now?
2021
Total mesorectal excision (TME) is the standard surgical treatment for the curative radical resection of rectal cancers. Minimally invasive TME has been gaining ground favored by the continuous technological advancements. New procedures, such as transanal TME (TaTME), have been introduced to overcome some technical limitations, especially in low rectal tumors, obese patients, and/or narrow pelvis. The earliest TaTME reports showed promising results when compared with the conventional laparoscopic TME. However, recent publications raised concerns regarding the high rates of anastomotic leaks or local recurrences observed in national series. Robotic TaTME (R-TaTME) has been proposed as a nove…
The 2017 Assisi Think Tank Meeting on rectal cancer: A positioning paper
2019
BACKGROUND AND PURPOSES: To describe current practice in the management of rectal cancer, to identify uncertainties that usually arise in the multidisciplinary team (MDT)'s discussions ('grey zones') and propose next generation studies which may provide answers to them. MATERIALS AND METHODS: A questionnaire on the areas of controversy in managing T2, T3 and T4 rectal cancer was drawn up and distributed to the Rectal-Assisi Think Tank Meeting (ATTM) Expert European Board. Less than 70% agreement on a treatment option was indicated as uncertainty and selected as a 'grey zone'. Topics with large disagreement were selected by the task force group for discussion at the Rectal-ATTM. RESULTS: The…
Comparison between MRI and pathology in the assessment of tumour regression grade in rectal cancer
2017
Background: Limited data exist regarding the correlation between MRI tumour regression grade (mrTRG) and pathological TRG (pTRG) in rectal cancer. Methods: mrTRG and pTRG were compared in rectal cancer patients from two phase II trials (EXPERT and EXPERT-C). The agreement between radiologist and pathologist was assessed with the weighted κ test while the Kaplan–Meier method was used to estimate survival outcomes. Results: One hundred ninety-one patients were included. Median time from completion of neoadjuvant treatment to pre-operative MRI and surgery was 4.1 weeks (interquartile range (IQR): 3.7–4.7) and 6.6 weeks (IQR: 5.9–7.6), respectively. Fair agreement was found between mrTRG and pT…
“Near-TME”: proposed standardisation of the technique for proctectomy in male patients with ulcerative colitis
2022
Abstract Background The aim of the present study was to describe in detail an approach to proctectomy in ulcerative colitis (UC), which can be standardized; near-total mesorectal excision (near-TME), to prevent injuries to autonomic pelvic nerves and subsequent sexual dysfunction. Methods We demonstrate the technique ex vivo on a cadaver from a male patient in lithotomy position and on a sagittal section of a male pelvis. We also demonstrate the technique in vivo in two male patients diagnosed with UC, with no history of sexual dysfunction or bowel neoplasia. The study was performed at the Human Embryology and Anatomy Department. University of Valencia, Spain. Results The posterolateral dis…
An international multicentre prospective audit of elective rectal cancer surgery; operative approach versus outcome, including transanal total mesore…
2018
Introduction: Transanal total mesorectal excision (TaTME) has rapidly emerged as a novel approach for rectal cancer surgery. Safety profiles are still emerging and more comparative data is urgently needed. This study aimed to compare indications and short-term outcomes of TaTME, open, laparoscopic, and robotic TME internationally. Methods: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients undergoing elective total mesorectal excision (TME) for malignancy between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. Results: Of 2579 included patients, 76.2% (1966/257…
Impact of inhalation vs. intravenous anaesthesia on autonomic nerves and internal anal sphincter tone.
2014
Background Pelvic intraoperative neuromonitoring (pIONM) aims to identify and spare the autonomic nerves and maintain patients’ quality of life. The effect of anaesthetic agents on the pIONM signal is unknown; therefore, the aim of the present study was to compare the influences of inhalation anaesthesia (IA) and total intravenous anaesthesia (TIVA). Methods Twenty rectal cancer patients undergoing open nerve-sparing total mesorectal excision (TME) were assigned to pIONM under either IA or TIVA (n = 10 per group). IA was maintained with sevoflurane and TIVA with propofol. During surgery, pelvic autonomic nerves were electrically stimulated under electromyography (EMG) of the internal anal s…
Head-Mounted Mixed-Reality Technology During Robotic-Assisted Transanal Total Mesorectal Excision
2019
INTRODUCTION Head-mounted mixed-reality technologies may enable advanced intraoperative visualization during visceral surgery. In this technical note, we describe an innovative use of real-time mixed reality during robotic-assisted transanal total mesorectal excision. TECHNIQUE Video signals from the robotic console and video endoscopic transanal approach were displayed on a virtual monitor using a head-up display. The surgeon, assistant, and a surgical trainee used this technique during abdominal and transanal robotic-assisted total mesorectal excision. We evaluated the feasibility and usability of this approach with the use of validated scales. RESULTS The technical feasibility of the rea…
Total mesorectal excision with intraoperative assessment of internal anal sphincter innervation provides new insights into neurogenic incontinence
2012
Background: The aim of this prospective study was to assess internal anal sphincter (IAS) innervation in patients undergoing total mesorectal excision (TME) by intraoperative neuromonitoring (IONM). Study Design: Fourteen patients underwent TME. IONM was carried out through pelvic splanchnic nerve stimulation under continuous electromyography of the IAS. Anorectal function was assessed with the digital rectal examination scoring system and a standardized questionnaire. Results: Nine of 11 patients who underwent low anterior resection had positive IONM results, with stimulation-induced increased IAS electromyographic amplitudes (median 0.23 V (interquartile range [IQR] 0.05, 0.56) vs median …
Selective approach for upper rectal cancer treatment: total mesorectal excision and preoperative chemoradiation are seldom necessary.
2015
The implementation of preoperative chemoradiation combined with total mesorectal excision has reduced local recurrence rates in rectal cancer. However, the use of both types of treatment in upper rectal cancer is controversial.The purpose of this work was to assess oncological results after radical resection of upper rectal cancers compared with sigmoid, middle, and lower rectal cancers and to determine risk factors for local recurrence in upper rectal cancer.This was a retrospective analysis of prospectively collected data.This study was conducted in a tertiary care referral hospital in Valencia, Spain.Analysis included 1145 patients who underwent colorectal resection with primary curative…