IRIS U kit usefulness in transanal total mesorectal excision for lower rectal cancer to avoid urethral injury

Abstract

Transanal total mesorectal excision (taTME) has improved the laparoscopic dissection for rectal cancer in the narrow pelvis. Although taTME has more clinical benefits than laparoscopic surgery, such as a better view of the distal rectum and direct determination of distal resection margin, an intraoperative urethral injury could occur in excision ta-TME. This study aimed to determine the feasibility and efficacy of the ta-TME with IRIS U kit surgery. This retrospective study enrolled 10 rectal cancer patients who underwent a taTME with an IRIS U kit. The study endpoints were the safety of access (intra- or postoperative morbidity). The detectability of the IRIS U kit catheter was investigated by using a laparoscope-ICG fluorescence camera system. Their mean age was 71.4±6.4 (58-78) years; 80 were men, and 2 were women. The mean operative time was 534.6 ± 94.5 min. The coloanal anastomosis was performed in 80%, and 20% underwent abdominal peritoneal resection. Two patients encountered postoperative complications graded as Clavien-Dindo grade 2. The transanal approach with IRIS U kit assistance is feasible, safe for patients with lower rectal cancer, and may prevent intraoperative urethral injury.

Keywords: IRIS U kit; Rectal cancer; Transanal; Urethral injury.

Fig. 1

IRIS U kit catheter system shows that an important demarcation line (red line) between the anterior rectal wall and the urethral duct (yellow arrow) could be visualized during transanal dissection in ta-TME ICG mode

Fig. 2

We can distinguish the prostatic segment of the urethra in real-time by using the infrared illumination system urethral kit (IRIS U kit)