J Minim Invasive Surg.  2016 Jun;19(2):79-80. 10.7602/jmis.2016.19.2.79.

Transanal Total Mesorectal Excision for Low Rectal Cancer

• Kim CW
• Chung Y
• Park SJ
• Lee KY
• Lee SH

• KMID: 2362242
• DOI: http://doi.org/10.7602/jmis.2016.19.2.79

Abstract

A 70-year-old female patient was diagnosed with low rectal adenocarcinoma (cT3N2) based on the initial CT and MRI. The patient underwent neoadjuvant chemoradiotherapy consisting of short course radiotherapy with 5-fluorouracil (5-FU) and leucovorin (LV) chemotherapy. Three additional cycles of simplified infusional 5-FU/LV were given every 2 weeks to the patient during the resting period (8 weeks) before surgery. For transanal TME, a purse-string suture of the distal rectum was performed just above the dentate line. Transanal circumferential dissection including the mesorectum was performed from the dentate line until the peritoneal reflection. Thereafter, laparoscopic dissection was conducted using the medial to lateral approach and the inferior mesenteric artery was ligated at the pedicle. Lateral detachment and splenic flexure mobilization were completed. After full mobilization of the distal transverse colon and rectum, the specimen was retrieved through the anus and resected. Colo-anal anastomosis was performed by the hand-sewn method. A closed suction drain was inserted into the pelvis. We also demonstrate our procedure for transanal TME using a short video clip.

Keyword

Total mesorectal excision; Rectal neoplasms; Transanal approach

MeSH Terms

Adenocarcinoma
Aged
Anal Canal
Chemoradiotherapy
Colon, Transverse
Drug Therapy
Female
Fluorouracil
Humans
Leucovorin
Magnetic Resonance Imaging
Mesenteric Artery, Inferior
Methods
Pelvis
Radiotherapy
Rectal Neoplasms*
Rectum
Suction
Sutures
Fluorouracil
Leucovorin