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Laparoscopy-Assisted Transanal Total Mesorectal Excision.

Dimitar K Penchev1, Plamen G Ivanov1, Ventzislav M Mutafchiyski1

  • 1Department of Endoscopic Endocrine Surgery and Coloproctology, Military Medical Academy, Sofia, Bulgaria.

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|July 14, 2019
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Summary

Laparoscopy-assisted transanal total mesorectal excision offers a promising minimally invasive approach for distal rectal cancer. Careful attention to the learning curve is crucial to avoid complications and ensure patient safety.

Keywords:
anterior rectal resectionrectal cancertransanal total mesorectal excision

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Area of Science:

  • Colorectal Surgery
  • Minimally Invasive Surgery
  • Surgical Oncology

Background:

  • Distal rectal cancer presents significant surgical challenges.
  • Transanal total mesorectal excision (TaTME) with laparoscopic assistance is an emerging technique to address these challenges.
  • This study presents initial experiences with laparoscopy-assisted TaTME.

Purpose of the Study:

  • To evaluate the feasibility and outcomes of laparoscopy-assisted transanal total mesorectal excision.
  • To present the surgical experience with this novel technique for distal rectal cancer.

Main Methods:

  • A prospective, non-randomized comparative trial was conducted.
  • Four laparoscopy-assisted TaTME procedures and two laparoscopic TME procedures were performed.
  • Patient data was collected between February 27, 2017, and October 1, 2017.

Main Results:

  • No conversions to open surgery were required in either group.
  • No postoperative mortality was observed within 30 days.
  • Satisfactory total mesorectal excision quality (Quirke classification) was achieved in all patients, with no positive margins except for one case of circumferential resection margin positivity. Two cases of postoperative morbidity were reported.

Conclusions:

  • Laparoscopy-assisted transanal total mesorectal excision is a novel, minimally invasive option for rectal cancer.
  • Minimizing procedure-related complications during the learning phase is critical for widespread adoption.
  • Further multicenter randomized controlled trials are necessary to validate these findings.