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Inflammatory Bowel Disease V: Surgical Management01:21

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Surgical interventions for inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease, are essential in managing symptoms and addressing complications. The selection of surgical procedures is contingent upon the specific conditions and complications that stem from these illnesses.
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Mesentery in Transanal TME.

Joep Knol1, Sami A Chadi2

  • 1Division of Colorectal Surgery, Colorectal and Minimally Invasive Surgery, ZOL Hospital, Genk, Belgium.

Clinics in Colon and Rectal Surgery
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Summary

Achieving oncological adequacy in rectal cancer surgery requires complete removal of the mesorectal package. Transanal total mesorectal excision (TME) offers improved access and quality for this challenging procedure.

Keywords:
mesenteryrectal cancertotal mesorectal excisiontransanal total mesorectal excision

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Area of Science:

  • Surgical Oncology
  • Colorectal Surgery
  • Minimally Invasive Surgery

Background:

  • Complete mesorectal excision is crucial for preventing local recurrence in rectal cancer.
  • Surgical technique and surgeon experience significantly impact the completeness of mesorectal resection.
  • Challenges in dissecting the distal rectum can affect oncological outcomes.

Purpose of the Study:

  • To discuss the introduction and application of transanal total mesorectal excision (TME).
  • To emphasize the importance of the mesentery, anatomy, and procedural steps in transanal TME.
  • To highlight the necessity of a structured training pathway for surgeons performing transanal TME.

Main Methods:

  • Review of total mesorectal excision (TME) principles and historical context.
  • Discussion of anatomical landmarks and embryological planes for dissection.
  • Exploration of transanal minimally invasive surgical techniques for TME.

Main Results:

  • Transanal TME can improve access and resection quality in narrow pelvic spaces.
  • Adherence to embryological planes and anatomical references is key for successful TME.
  • Standardization, education, and training are vital for optimizing surgical outcomes.

Conclusions:

  • Transanal TME presents a viable approach to enhance rectal cancer surgery outcomes.
  • Mastery of relevant anatomy and standardized procedural steps are essential for transanal TME.
  • A robust training pathway is critical for widespread adoption and proficiency in transanal TME.