Antonio M Lacy (Director of Department of Gastrointestinal Surgery)
María Fernández-Hevia (Gastrointestinal Surgery Specialist)
Hospital Clínic, Barcelona, Spain
A 69 year old male patient without relevant medical or surgical record, BMI of 27 was diagnosed of rectal cancer thanks a to population screening program. By colonoscopy the tumor was a 15 cm from the anal verge and CT Scan ruled out metastatic disease.
Radical surgery was accomplished by a novel approach (Cecil Approach), two teams working at the same time had performed a transanal partial mesorectal excision (taTME).
After the placement of the transanal device the pneumorectum is started and a running suture of ProleneⓇ was made at the distal margin. The smoke is the main problem at this stage of the procedure. The dissection of the mesorectum begins after sectioning the rectal wall, this maneuver must be done perpendicular to the rectal lumen and in a circumferential manner.
The surgery progress down-to-up while the abdominal team dissect the inferior mesenteric vessels and mobilize the sigmoid colon. High arterial ligation is safely performed with a LigaSureTM .
The collaboration between the two teams is crucial at the highest part of the rectum, it helps to improve the control of the specimen and to avoid unexpected injuries. After complete mobilization of the specimen the transanal team built a running suture of the rectal stump with laparoscopic instruments.
The specimen was extracted transanally and sectioned above the inferior mesenteric vessels. An end-to-end stapled anastomosis was created under laparoscopic supervision.
Pathology examination revealed a pT3N1b low grade adenocarcinoma with free margins (distal = 4.5 cm, circumferential = 12 mm, intact mesorectal fascia).