scholarly journals AB009. 14. Laparoscopic proctocolectomy with intersphincteric resection and transanal total mesorectal excision

2019 ◽  
Vol 3 ◽  
pp. AB009-AB009
Author(s):  
Cillian Clancy ◽  
Tayyaub Mansoor ◽  
John Burke
Keyword(s):  
Total Mesorectal Excision ◽  
Intersphincteric Resection ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Laparoscopic Proctocolectomy

scholarly journals Assessment of the result of laparoscopic intersphincteric resection, transanal total mesorectal excision for low rectal cancer

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Văn Quốc Lê ◽  
Keyword(s):  
Rectal Cancer ◽  
Lymph Nodes ◽  
Total Mesorectal Excision ◽  
Intersphincteric Resection ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Metastatic Lymph Nodes ◽  
Metastatic Lymph ◽  
Long Course ◽  
Laparoscopic Intersphincteric Resection

Tóm tắt Đặt vấn đề: Đánh giá kết quả phẫu thuật nội soi hoàn toàn cắt gian cơ thắt (Intersphincteric resection – ISR), toàn bộ mạc treo trực tràng qua đường hậu môn (Transanal total mesorectal excision – TaTME) điều trị ung thư trực tràng thấp. Phương pháp nghiên cứu: Nghiên cứu mô tả tiến cứu những người bệnh (NB) được phẫu thuật nội soi hoàn toàn ISR, TaTME điều trị ung thư trực tràng thấp tại khoa phẫu thuật (PT) Hậu môn – Trực tràng, Bệnh viện Trung ương Quân đội 108 từ tháng 6/2018 – 9/2019. Kết quả: 67 NB (47 nam, 20 nữ), tuổi trung bình 62,7 ± 9,3 tuổi (40 - 82). Khoảng cách từ bờ dưới khối u tới mép hậu môn: 4.4 ± 0,8 cm (2,5 - 5,5). Mức độ xâm lấn khối u (T) trước mổ 65,7% T4; 31,3% T3, 3,0% T2, 84,9% hạch nghi ngờ di căn giai đoạn (GĐ) trước hóa xạ trị (HXT) dài ngày 98,1% III, 1,9% II. Có 14,9% NB không hoá xạ trị (HXT) tiền phẫu; 4,5% xạ trị tiền phẫu ngắn ngày; 80,6% HXT tiền phẫu dài ngày. Mức độ xâm lấn khối u sau HXT dài ngày 61,1% T3, 38,9% T2; 46,3% hạch nghi ngờ di căn (GĐ sau HXT dài ngày 46,3% III, 24,1% II, 29,6% I). Có 35,8% cắt 1 phần; 56,7% cắt bán phần và 7,5% cắt toàn bộ cơ thắt trong. Có 6% NB làm dẫn lưu hồi tràng. Thời gian phẫu thuật trung bình 151,6 phút, số lượng máu mất trung bình 57 ml, thời gian nằm viện trung bình 12,2 ngày. Diện cắt đầu xa, đầu gần, diện cắt chu vi không thấy tế bào u: 100%. Số lượng hạch trung bình vét được 5,3 hạch. GĐ sau mổ 38,9% III, 23,9% II, 25,4% I, 11,6% GĐ 0; 37,3% NB hạch di căn (GĐ sau mổ ở NB HXT 29,7% III, 24,1% II, 29,6% I, 16,7 GĐ 0). Tỷ lệ biến chứng chung: 15,0%. Thời gian theo dõi 6 tháng: 2 NB tái phát tại chỗ; 1 NB di căn gan. Chức năng hậu môn đánh giá theo thang điểm Wexner trước mổ, sau mổ 1 tháng, 6 tháng lần lượt là 13.0 ± 3.8; 11.5 ± 4.9 và 9.1 ± 5.6. Kết luận: Phẫu thuật nội soi hoàn toàn cắt gian cơ thắt, toàn bộ mạc treo trực tràng qua đường hậu môn điều trị ung thư trực tràng là khả thi, an toàn, đảm bảo về mặt ung thư học. Chức năng hậu môn tốt dần theo thời gian. Abstract Introduction: To assess the results of laparoscopic for intersphincteric resection (ISR), (Transanal total mesorectal excision – TaTME) for rectal cancer. Materials and Methods: A descriptive retrospective study of patients underwent laparoscopic for intersphincteric resection, TaTME at the Department of Colon and Rectal, 108 Military Central Hospital from June 2018 to September 2019. Results: 67 patients (47 males, 20 females), average age 62.7 ± 9,3 (40 - 82 years). The average distance from the bottom of the tumor to the anal verge: 4.4 ± 0.8 cm (2.5 – 5.5). Preoperative stage were: 65,7 % T4; 31,3 % T3, 3,0 % T2, 84,.9% suspected metastatic lymph nodes (Stage of before long - course chemoradiotherapy were 98.1% III, 1.9% II). There were 14,9% of patients have no preoperative radiotherapy; 4.5% have short-course radiotherapy ; 80.6% have Preoperative chemoradiotherapy for long-course; Staging after chemoradiotherapy: 61.1% T3, 38.9% T2; 46.3% suspected metastatic lymph nodes (Stage of after long - course chemoradiotherapy were 46.3% III, 24.1% II, 29.6% I. The partial intersphincteric resection accounted for 35.8%; subtotal intersphincteric resection accounted for 56.7%; 7.5% total intersphincteric resection, 6% ileostomy was conducted. The average time of surgery was 151.6 minutes, the average amount of blood lost was 57ml, the average length of hospital stay was 12.2 days. Free tumor tissue in distal and proximal areas as well as circumference site were 100% specimens. The average number of lymph nodes removed: 5.3. The postoperative stages were : 38,9% III, 23,9% II, 25,4% I, 11,6% T0. Metastatic lymph nodes (Stage of postoperative chemoradiotherapy were 29,7% T III, 24,1% TII, 29,6% TI, 16,7 T0). General complications were 15.0%. Six month follow-up found two local recurrence; one metastatic liver. The anal function assessed by Wexner score before, after surgery 1 month and 6 months were 13.0 ± 3.8; 11.5 ± 4.9 và 9.1 ± 5.6. Conclusion: Laparoscopic intersphincteric resection, transanal total mesorectal excision for low rectal cancer was feasible, safe oncology aspects ; Anal function improves with time. Keywords: Laparoscopic for Intersphincteric resection (ISR); transanal total mesorectal excision (TaTME); Wexner score.

Wasmuth HH, Færden AE, Myklebust TÅ, et al (2020) Transanal total mesorectal excision for rectal cancer has been suspended in Norway. Br J Surg 107:121–30

2020 ◽  
Vol 14 (3) ◽  
pp. 155-158
Author(s):  
M. Aubert ◽  
Y. Panis
Keyword(s):  
Rectal Cancer ◽  
Total Mesorectal Excision ◽  
Cancer Du Rectum ◽  
Prise En Charge ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Récidive Locale ◽  
Kaplan Meier ◽  
Cancers Colorectaux ◽  
Technique Chirurgicale

Contexte : L’exérèse totale du mésorectum par voie transanale (TaTME) pour la prise en charge du cancer du rectum est récemment apparue comme alternative à l’exérèse totale du mésorectum par voie abdominale. Cependant, certaines inquiétudes à propos des résultats oncologiques de cette technique chirurgicale ont émergé. Le but de cette étude était d’évaluer le taux de récidives locales après TaTME. Les objectifs secondaires s’intéressaient à la mortalité postopératoire, au taux de fistule anastomotique et au taux de stomie définitive. Méthodes : Les données de tous les patients opérés par TaTME ont été rapportées et comparées aux données issues des registres nationaux norvégiens de cancers colorectaux (NCCR) et de chirurgie gastro-intestinale (NoRGast). Les taux de récidive locale étaient estimés selon Kaplan-Meier. Résultats : En Norvège, 157 patients ont été opérés par TaTME pour un cancer du rectum entre octobre 2014 et octobre 2018. Trois des sept centres hospitaliers participants ont abandonné la réalisation de cette intervention après cinq procédures. Le taux de récidive locale était de 12 sur 157 patients (7,6 %) ; huit récidives locales étaient multifocales ou étendues. Le taux de récidive locale après un suivi de à 2,4 ans était estimé à 11,6 % (IC 95 % : [6,6‒19,9]) après TaTME contre 2,4 % (IC 95 % : [1,4‒4,4]) dans le registre NCCR (p < 0,001). Le hasard ratio était estimé à 6,71 (IC 95 % : [2,94‒15,32]). Le taux de fistule anastomotique nécessitant une réintervention était de 8,4 % dans le groupe TaTME contre 4,5 % dans le registre NoRGast (p = 0,047). Cinquante-six patients (35,7 %) étaient porteurs d’une stomie à la fin du suivi, dont 39 (24,8 %) étaient définitives. Conclusion : Le taux de fistule anastomotique était plus élevé après TaTME en comparaison aux données des registres nationaux norvégiens. Le taux de récidive locale ainsi que les caractéristiques de cette récidive après TaTME étaient défavorables.

scholarly journals Deep learning-based automatic surgical step recognition in intraoperative videos for transanal total mesorectal excision

2021 ◽  
Author(s):  
Daichi Kitaguchi ◽  
Nobuyoshi Takeshita ◽  
Hiroki Matsuzaki ◽  
Hiro Hasegawa ◽  
Takahiro Igaki ◽  
...  
Keyword(s):  
Deep Learning ◽  
Total Mesorectal Excision ◽  
Rectal Wall ◽  
Learning Model ◽  
Video Indexing ◽  
Video Data ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Purse String ◽  
Deep Learning Model

Abstract Background Dividing a surgical procedure into a sequence of identifiable and meaningful steps facilitates intraoperative video data acquisition and storage. These efforts are especially valuable for technically challenging procedures that require intraoperative video analysis, such as transanal total mesorectal excision (TaTME); however, manual video indexing is time-consuming. Thus, in this study, we constructed an annotated video dataset for TaTME with surgical step information and evaluated the performance of a deep learning model in recognizing the surgical steps in TaTME. Methods This was a single-institutional retrospective feasibility study. All TaTME intraoperative videos were divided into frames. Each frame was manually annotated as one of the following major steps: (1) purse-string closure; (2) full thickness transection of the rectal wall; (3) down-to-up dissection; (4) dissection after rendezvous; and (5) purse-string suture for stapled anastomosis. Steps 3 and 4 were each further classified into four sub-steps, specifically, for dissection of the anterior, posterior, right, and left planes. A convolutional neural network-based deep learning model, Xception, was utilized for the surgical step classification task. Results Our dataset containing 50 TaTME videos was randomly divided into two subsets for training and testing with 40 and 10 videos, respectively. The overall accuracy obtained for all classification steps was 93.2%. By contrast, when sub-step classification was included in the performance analysis, a mean accuracy (± standard deviation) of 78% (± 5%), with a maximum accuracy of 85%, was obtained. Conclusions To the best of our knowledge, this is the first study based on automatic surgical step classification for TaTME. Our deep learning model self-learned and recognized the classification steps in TaTME videos with high accuracy after training. Thus, our model can be applied to a system for intraoperative guidance or for postoperative video indexing and analysis in TaTME procedures.

A systematic review and meta‐analysis on complications of Transanal Total Mesorectal Excision

2021 ◽  
Author(s):  
Yongbo An ◽  
Sapho X. Roodbeen ◽  
Kevin Talboom ◽  
Pieter J. Tanis ◽  
Willem A. Bemelman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Mesorectal Excision ◽  
Meta Analysis ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision

scholarly journals The value of force and torque measurements in transanal total mesorectal excision (TaTME)

2019 ◽  
Vol 23 (9) ◽  
pp. 843-852
Author(s):  
S. F. Hardon ◽  
R. J. van Kasteren ◽  
J. Dankelman ◽  
H. J. Bonjer ◽  
J. B. Tuynman ◽  
...  
Keyword(s):  
Total Mesorectal Excision ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Torque Measurements
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