Frameless stereotaxy is an established method for real-time image-guided surgical navigation in neurological surgery. Though this is capable of providing sub-millimeter accuracy, it has not been used by other surgical specialists.
Methods and procedure
A patient with locally advanced, distal rectal cancer and tumor abutting the prostate was selected for transanal TME using TAMIS, with intra-operative CT-guided navigation to ensure an R0 resection.
The use of stereotactic TAMIS-TME was successfully performed with an accuracy of ±4 mm. The surgical specimen revealed an R0 resection, and this new approach aided in achieving adequate resection margins.
This is the first report of the use of frameless stereotactic navigation beyond the scope of neurosurgery. Stereotactic navigation for transanal total mesorectal excision is shown to be feasible. Stereotactic navigation may potentially be applied toward other pelvic and fixed abdominal organs, thereby opening the gateway for a broader use by the general surgeon.
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Thanks to Ross Lumsden and David Rosen MD for his instruction regarding frameless navigation. Assistance with surgical logistics and photographic documentation provided by Denise Roebuck, L. Randy Andrus, Sohaib Shamsi, Nancy Sanfrancesco, Brandon Nieves, and Ashley Watson.
Dr. S. Atallah is a paid consultant for Applied Medical, Inc. and Life Cell. Dr. S. Larach is a paid consultant for Applied Medical, Inc. Dr. G. Nassif has no financial disclosures. This study received no funding.
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Atallah, S., Nassif, G. & Larach, S. Stereotactic navigation for TAMIS-TME: opening the gateway to frameless, image-guided abdominal and pelvic surgery. Surg Endosc 29, 207–211 (2015) doi:10.1007/s00464-014-3655-y
- Stereotactic surgery
- Transanal stereotaxy
- Transanal TME
- Image-guided surgery