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Case Reports
. 2015 Apr-Jun;28(2):117-20.
doi: 10.1590/S0102-67202015000200008.

Transanal minimally invasive surgery for total mesorectal excision (ETM) through transanal approach (TaETM) with robotic and Transanal Endoscopic Operations (TEO) combined access: step by step surgery

[Article in English, Portuguese]
Carlos Ramon Silveira Mendes  1 , Marcus Valadão  1 , Rodrigo Araújo  1 , Eduardo Linhares  1 , José Paulo Jesus  1
Affiliations
Case Reports

Transanal minimally invasive surgery for total mesorectal excision (ETM) through transanal approach (TaETM) with robotic and Transanal Endoscopic Operations (TEO) combined access: step by step surgery

[Article in English, Portuguese]
Carlos Ramon Silveira Mendes et al. Arq Bras Cir Dig. 2015 Apr-Jun.

Abstract
in English, Portuguese

Rational: In the treatment of colorectal cancer, from 1982 Heald proposed standardization of the total mesorectal excision, with a significant reduction in the recurrence rate. But the treatment of lower rectal lesions is still a challenge.

Aim: To describe the association of robotic low anterior resection- TATA (Transanal Abdominal Transanal Resection), with transanal access using Transanal Endoscopic Operations - TEO in the treatment of lower rectal cancer.

Method: The TATA performs robotic abdominal approach and the TEO performs the perineal approach, developing total mesorectal excision (TME) transanally (TaETM).

Result: The TaETM technique was applied in a woman with rectal adenocarcinoma 5 cm from the anal verge that had been submitted to chemoradiation. The procedure was performed with satisfatory operative time and favorable oncological outcome (grade 3 mesorectal excision).

Conclusion: This is a promising minimally invasive procedure in the armamentarium of rectal cancer treatment, specially in challenging scenarios such as narrow pelvis, obesity and very low rectal tumors.

Racional: No tratamento do câncer colorretal, a partir de 1982 Heald propôs padronização da excisão total do mesorreto, com redução importante no índice de recidivas. Apesar disso, o tratamento das lesões do reto inferior ainda permanecem um desafio.

Objetivo: Descrever a associação da abordagem robótica por via abdominal - TATA (Transanal Abdominal Transanal Resection), com o acesso transanal utilizando o Transanal Endoscopic Operations - TEO no tratamento do câncer de reto inferior.

Método: A TATA realiza o tempo abdominal por robótica e o TEO o tempo perineal, desenvolvendo a excisão total do mesorreto (ETM) por via transanal (TaETM).

Resultado: A técnica TaETM foi aplicada em mulher com adenocarcinoma de reto a 5 cm da margem anal que tinha sido submetida à radioquimioterapia. O procedimento foi realizado com um tempo cirúrgico satisfatório bem como resultado oncológico favorável (ressecção mesorretal grau 3). Paciente obteve alta no segundo dia pós-operatório com seguimento ambulatorial satisfatório.

Conclusão: Trata-se de um procedimento minimamente invasivo bastante promissor no arsenal terapêutico do câncer de reto, principalmente em situações de maior dificuldade técnica como pelve estreita, obesidade e lesões do reto distal.

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Conflict of interest statement

Conflicts of interest: none

Figures

Figure 1.
Figure 1.
Arrangement of trocars
Figure 2.
Figure 2.
Diagonal robotic docking
Figure 3.
Figure 3.
Position of the robotic arms
Figure 4.
Figure 4.
Transanal Endoscopic Operations - TEO (Storz, Tuttlingen, Germany)
Figure 5.
Figure 5.
MRI lesion pretreatment T3N1M0
Figure 6.
Figure 6.
MRI after neoadjuvant therapy (radiation and chemotherapy)
See this image and copyright information in PMC

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References

    1. Atallah SB, Albert MR, deBeche-Adams TH, Larach SW. Robotic transanal minimally invasive surgery in a cadaveric model. Tech Coloproctol. 2011;15:461–464. - PubMed
    1. Araujo SEA. Transanal endoscopic microsurgery: a Brazilian initial experience in provate pratice. Hepato-Gastroenterology. 2012;59:118–118. - PubMed
    1. Aziz O, Constantinides V, Tekkis P. Laparoscopic versus open surgery for rectalcancer: A meta-analysis. Ann Surg Oncol. 2006;13:413–424. - PubMed
    1. Araujo SE, Crawshaw B, Mendes CR, Delaney CP. Transanal total mesorectal excision: a systematic review of the experimental and clinical evidence. TechColoproctol. 2014 - PubMed
    1. Balli C, Ziogas D, Roukos D, Baltogiannis G. Laparoscopic and robotic rectal câncerresection: Expectations for improving oncological outcomes. Ann Surg. 2010;251:185–185. - PubMed

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