Download PDF
Clin Colon Rectal Surg 2020; 33(03): 157-167
DOI: 10.1055/s-0040-1701604
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Anatomical Considerations and Procedure-Specific Aspects Important in Preventing Operative Morbidity during Transanal Total Mesorectal Excision

Sam Atallah
1   Department of Colorectal Surgery, Florida Hospital, Orlando, Florida
› Author Affiliations
Further Information

Publication History

Publication Date:
28 April 2020 (online)

    Permissions and Reprints

Abstract

As transanal total mesorectal excision (taTME) becomes increasingly utilized, its technical challenges and potential pitfalls have become more clearly appreciated. This chapter explores the differences in how anatomy presents itself from the taTME vantage point as compared with traditional approaches to taTME, and how special problems unique to taTME pose a new set of operative challenges. Morbidity related, specifically, to the technique of taTME is also delineated with particular focus on male urethral injury.

Keywords

taTME - transanal total mesorectal excision - operative morbidity - operative technique - male urethral injury
 

  • References

  • 1 Atallah S, Albert M, Monson JR. Critical concepts and important anatomic landmarks encountered during transanal total mesorectal excision (taTME): toward the mastery of a new operation for rectal cancer surgery. Tech Coloproctol 2016; 20 (07) 483-494
    CrossrefPubMedGoogle Scholar
  • 2 Penna M, Hompes R, Arnold S. , et al; International TaTME Registry Collaborative. Incidence and risk factors for anastomotic failure in 1594 patients treated by transanal total mesorectal excision: results from the international TaTME registry. Ann Surg 2019; 269 (04) 700-711
    CrossrefPubMedGoogle Scholar
  • 3 Buchs NC, Penna M, Bloemendaal AL, Hompes R. Transanal total mesorectal excision: myths and reality. World J Clin Oncol 2016; 7 (05) 337-339
    CrossrefPubMedGoogle Scholar
  • 4 Atallah SB, DuBose AC, Burke JP. , et al. Uptake of transanal total mesorectal excision in north america: initial assessment of a structured training program and the experience of delegate surgeons. Dis Colon Rectum 2017; 60 (10) 1023-1031
    CrossrefPubMedGoogle Scholar
  • 5 Atallah S, Gonzalez P, Chadi S, Hompes R, Knol J. Operative vectors, anatomic distortion, fluid dynamics and the inherent effects of pneumatic insufflation encountered during transanal total mesorectal excision. Tech Coloproctol 2017; 21 (10) 783-794
    CrossrefPubMedGoogle Scholar
  • 6 Nicholson G, Knol J, Houben B, Cunningham C, Ashraf S, Hompes R. Optimal dissection for transanal total mesorectal excision using modified CO2 insufflation and smoke extraction. Colorectal Dis 2015; 17 (11) O265-O267
    CrossrefPubMedGoogle Scholar
  • 7 Bislenghi G, Wolthuis AM, de Buck van Overstraeten A, D'Hoore A. AirSeal system insufflator to maintain a stable pneumorectum during TAMIS. Tech Coloproctol 2015; 19: 43-45
    CrossrefPubMedGoogle Scholar
  • 8 Nepple KG, Kallogjeri D, Bhayani SB. Benchtop evaluation of pressure barrier insufflator and standard insufflator systems. Surg Endosc 2013; 27 (01) 333-338
    CrossrefPubMedGoogle Scholar
  • 9 Horstmann M, Horton K, Kurz M, Padevit C, John H. Prospective comparison between the AirSeal® system valve-less Trocar and a standard Versaport™ Plus V2 Trocar in robotic-assisted radical prostatectomy. J Endourol 2013; 27 (05) 579-582
    CrossrefPubMedGoogle Scholar
  • 10 Waheed A, Miles A, Kelly J, Monson JRT, Motl JS, Albert M. Insufflation stabilization bag (ISB): a cost-effective approach for stable pneumorectum using a modified CO2 insufflation reservoir for TAMIS and taTME. Tech Coloproctol 2017; 21 (11) 897-900
    CrossrefPubMedGoogle Scholar
  • 11 Leroy J, Diana M, Barry B. , et al. Perirectal oncologic gateway to retroperitoneal endoscopic single-site surgery (PROGRESSS): a feasibility study for a new NOTES approach in a swine model. Surg Innov 2012; 19 (04) 345-352
    CrossrefPubMedGoogle Scholar
  • 12 Velthuis S, Veltcamp Helbach M, Tuynman JB, Le TN, Bonjer HJ, Sietses C. Intra-abdominal bacterial contamination in TAMIS total mesorectal excision for rectal carcinoma: a prospective study. Surg Endosc 2015; 29 (11) 3319-3323
    CrossrefPubMedGoogle Scholar
  • 13 Rygick AN, Fain SN, Pestovskaja GN. Viability of cancer cells penetrating tissues during operations for cancer of the rectum. Dis Colon Rectum 1969; 12 (05) 351-356
    CrossrefPubMedGoogle Scholar
  • 14 Umpleby HC, Fermor B, Symes MO, Williamson RC. Viability of exfoliated colorectal carcinoma cells. Br J Surg 1984; 71 (09) 659-663
    CrossrefPubMedGoogle Scholar
  • 15 Tsunoda A, Shibusawa M, Kamiyama G, Takata M, Yokoyama N, Kusano M. Viability of free malignant cells in specimens removed because of colorectal carcinoma. JPN J Gastroenterol Surg 1996; 29: 1022-1027
    CrossrefPubMedGoogle Scholar
  • 16 Keynes WM. Implantation from the bowel lumen in cancer of the large intestine. Ann Surg 1961; 153: 357-364
    CrossrefPubMedGoogle Scholar
  • 17 Long RT, Edwards RH. Implantation metastasis as a cause of local recurrence of colorectal carcinoma. Am J Surg 1989; 157 (02) 194-201
    CrossrefPubMedGoogle Scholar
  • 18 McGREW EA, Laws JF, Cole WH. Free malignant cells in relation to recurrence of carcinoma of the colon. J Am Med Assoc 1954; 154 (15) 1251-1254
    CrossrefPubMedGoogle Scholar
  • 19 Vink M. Local recurrence of cancer in the large bowel: the role of implantation metastases and bowel disinfection. Br J Surg 1954; 41 (168) 431-433
    CrossrefPubMedGoogle Scholar
  • 20 Sayfan J, Averbuch F, Koltun L, Benyamin N. Effect of rectal stump washout on the presence of free malignant cells in the rectum during anterior resection for rectal cancer. Dis Colon Rectum 2000; 43 (12) 1710-1712
    CrossrefPubMedGoogle Scholar
  • 21 Ghafoori M, Shakiba M, Seifmanesh H, Hoseini K. Decrease in infection rate following use of povidone-iodine during transrectal ultrasound guided biopsy of the prostate: a double blind randomized clinical trial. Iran J Radiol 2012; 9 (02) 67-70
    CrossrefPubMedGoogle Scholar
  • 22 Hwang EC, Jung SI, Seo YH. , et al. Risk factors for and prophylactic effect of povidone-iodine rectal cleansing on infectious complications after prostate biopsy: a retrospective cohort study. Int Urol Nephrol 2015; 47 (04) 595-601
    CrossrefPubMedGoogle Scholar
  • 23 Abughosh Z, Margolick J, Goldenberg SL. , et al. A prospective randomized trial of povidone-iodine prophylactic cleansing of the rectum before transrectal ultrasound guided prostate biopsy. J Urol 2013; 189 (04) 1326-1331
    CrossrefPubMedGoogle Scholar
  • 24 Scammell BE, Phillips RP, Brown R, Burdon DW, Keighley MRB. Influence of rectal washout on bacterial counts in the rectal stump. Br J Surg 1985; 72 (07) 548-550
    CrossrefPubMedGoogle Scholar
  • 25 Shafik A. New concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. II. Anatomy of the levator ani muscle with special reference to puborectalis. Invest Urol 1975; 13 (03) 175-182
    PubMedGoogle Scholar
  • 26 Kinugasa Y, Arakawa T, Abe S. , et al. Anatomical reevaluation of the anococcygeal ligament and its surgical relevance. Dis Colon Rectum 2011; 54 (02) 232-237
    CrossrefPubMedGoogle Scholar
  • 27 Nakajima Y, Muro S, Nasu H, Harada M, Yamaguchi K, Akita K. Morphology of the region anterior to the anal canal in males: visualization of the anterior bundle of the longitudinal muscle by transanal ultrasonography. Surg Radiol Anat 2017; 39 (09) 967-973
    CrossrefPubMedGoogle Scholar
  • 28 Muro S, Yamaguchi K, Nakajima Y. , et al. Dynamic intersection of the longitudinal muscle and external anal sphincter in the layered structure of the anal canal posterior wall. Surg Radiol Anat 2014; 36 (06) 551-559
    CrossrefPubMedGoogle Scholar
  • 29 Tsukada Y, Ito M, Watanabe K. , et al. Topographic anatomy of the anal sphincter complex and levator ani muscle as it relates to intersphincteric resection for very low rectal disease. Dis Colon Rectum 2016; 59 (05) 426-433
    CrossrefPubMedGoogle Scholar
  • 30 Rouanet P, Mourregot A, Azar CC. , et al. Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum 2013; 56 (04) 408-415
    CrossrefPubMedGoogle Scholar
  • 31 Atallah S, Mabardy A, Volpato AP, Chin T, Sneider J, Monson JRT. Surgery beyond the visible light spectrum: theoretical and applied methods for localization of the male urethra during transanal total mesorectal excision. Tech Coloproctol 2017; 21 (06) 413-424
    CrossrefPubMedGoogle Scholar
  • 32 Burke JP, Martin-Perez B, Khan A. , et al. Transanal total mesorectal excision for rectal cancer: early outcomes in 50 consecutive patients. Colorectal Dis 2016; 18 (06) 570-577
    CrossrefPubMedGoogle Scholar
  • 33 Uematsu D, Akiyama G, Sugihara T, Magishi A, Yamaguchi T, Sano T. Transanal total pelvic exenteration: pushing the limits of transanal total mesorectal excision with transanal pelvic exenteration. Dis Colon Rectum 2017; 60 (06) 647-648
    CrossrefPubMedGoogle Scholar
  • 34 Maykel JA. Comprehensive training and safe implementation of a transanal total mesorectal excision program. Dis Colon Rectum 2017; 60 (10) 995-996
    CrossrefPubMedGoogle Scholar
  • 35 Maykel JA, Phatak UR, Suwanabol PA. , et al. Initiation of a transanal total mesorectal excision program at an academic training program: evaluating patient safety and quality outcomes. Dis Colon Rectum 2017; 60 (12) 1267-1272
    CrossrefPubMedGoogle Scholar
  • 36 Walsh PC. Anatomical studies of the neurovascular bundle and cavernosal nerves. J Urol 2005; 174 (02) 566
    CrossrefPubMedGoogle Scholar
  • 37 Atallah S, Albert M. The neurovascular bundle of Walsh and other anatomic considerations crucial in preventing urethral injury in males undergoing transanal total mesorectal excision. Tech Coloproctol 2016; 20 (06) 411-412
    CrossrefPubMedGoogle Scholar
  • 38 Kneist W, Stelzner S, Aigner F, Fürst A, Wedel T. Urethral injury in body donor TaTME training. Coloproctol 2017; 39 (03) 179-183
    CrossrefPubMedGoogle Scholar
  • 39 Hoffman D. Visual intelligence—How We Create What We See. New York, NY: WW Norton & Co; 1998
    Google Scholar
  • 40 Liinasuo M, Kojo I, Häkkinen J, Rovamo J. Visual completion of three-dimensional, chromatic, moving stimuli in humans. Neurosci Lett 2004; 354 (01) 18-21
    CrossrefPubMedGoogle Scholar
  • 41 Kanizsa G. Quasi-perceptual margins in homogeneously stimulated fields. In: Petry S, Meyer GE. , eds. The Perception of Illusory Contours. New York, NY: Springer; 1987: 40-49
    CrossrefGoogle Scholar
  • 42 Ginsburg AP. Is the illusory triangle physical or imaginary?. Nature 1975; 257 (5523): 219-220
    CrossrefPubMedGoogle Scholar
  • 43 Way LW, Stewart L, Gantert W. , et al. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg 2003; 237 (04) 460-469
    PubMedGoogle Scholar
  • 44 Windsor JA, Pong J. Laparoscopic biliary injury: more than a learning curve problem. Aust N Z J Surg 1998; 68 (03) 186-189
    CrossrefPubMedGoogle Scholar
  • 45 Moossa AR, Easter DW, Van Sonnenberg E, Casola G, D'Agostino H. Laparoscopic injuries to the bile duct. A cause for concern. Ann Surg 1992; 215 (03) 203-208
    CrossrefPubMedGoogle Scholar
  • 46 Hastie R, Dawes RM. Rational Choice in an Uncertain World. The Psychology of Judgment and Decision Making. Thousand Oaks, CA: Sage Publications: 2001
    Google Scholar
  • 47 Hogarth RM. Educating Intuition. Chicago, MI: University of Chicago Press Ltd.; 2001
    Google Scholar
  • 48 Klayman J. Varieties of confirmation bias. Psychol Learn Motiv 1995; 32: 385-418
    PubMedGoogle Scholar
  • 49 Bornstein BH, Emler AC. Rationality in medical decision making: a review of the literature on doctors' decision-making biases. J Eval Clin Pract 2001; 7 (02) 97-107
    CrossrefPubMedGoogle Scholar
  • 50 Atallah S, Martin-Perez B, Drake J, Stotland P, Ashamalla S, Albert M. The use of a lighted stent as a method for identifying the urethra in male patients undergoing transanal total mesorectal excision: a video demonstration. Tech Coloproctol 2015; 19 (06) 375
    CrossrefPubMedGoogle Scholar
  • 51 Barnes TG, Penna M, Hompes R, Cunningham C. Fluorescence to highlight the urethra: a human cadaveric study. Tech Coloproctol 2017; 21 (06) 439-444
    CrossrefPubMedGoogle Scholar
  • 52 Sahnan K, Pellino G, Adegbola SO. , et al. Development of a model of three-dimensional imaging for the preoperative planning of TaTME. Tech Coloproctol 2018; 22 (01) 59-63
    CrossrefPubMedGoogle Scholar
  • 53 Harlaar NJ, Koller M, de Jongh SJ. , et al. Molecular fluorescence-guided surgery of peritoneal carcinomatosis of colorectal origin: a single-centre feasibility study. Lancet Gastroenterol Hepatol 2016; 1 (04) 283-290
    PubMedGoogle Scholar
  • 54 Mondal SB, Gao S, Zhu N. , et al. Optical see-through cancer vision goggles enable direct patient visualization and real-time fluorescence-guided oncologic surgery. Ann Surg Oncol 2017; 24 (07) 1897-1903
    CrossrefPubMedGoogle Scholar
  • 55 Mela CA, Patterson C, Thompson WK, Papay F, Liu Y. Stereoscopic integrated imaging goggles for multimodal intraoperative image guidance. PLoS One 2015; 10 (11) e0141956
    CrossrefPubMedGoogle Scholar
  • 56 Goldman SM, Sandler CM, Corriere Jr. JN, McGuire EJ. Blunt urethral trauma: a unified, anatomical mechanical classification. J Urol 1997; 157 (01) 85-89
    CrossrefPubMedGoogle Scholar
  • 57 Ay A, Demir A, Kismet K, Emir L, Ertas E. Idiopathic giant atonic bladder (6000 mL in volume) present for 15 years with no urinary symptoms. Can Urol Assoc J 2013; 7 (1,2): E135-E137
    CrossrefPubMedGoogle Scholar
  • 58 Penna M, Knol JJ, Tuynman JB, Tekkis PP, Mortensen NJ, Hompes R. Four anastomotic techniques following transanal total mesorectal excision (TaTME). Tech Coloproctol 2016; 20 (03) 185-191
    CrossrefPubMedGoogle Scholar