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The use of a lighted stent as a method for identifying the urethra in male patients undergoing transanal total mesorectal excision: a video demonstration

The application of transanal minimally invasive surgery (TAMIS) for total mesorectal excision (TME) has undergone rapid adoption by expert colorectal surgeons worldwide [1]. It represents one of the most important new techniques for the management of distal rectal cancer [2]. However, the unique approach from below is unfamiliar to rectal cancer surgeons and mandates appropriate training and education. Even with adequate training, there is a risk of urethral injury with TAMIS-TME [3].

This video demonstrates how the male urethra can be injured during transanal TME and then describes a simple method for identifying the urethra. On a cadaveric model, a clear 24 Fr Foley catheter is introduced into the bladder. Through the Foley, a lighted ureteral stent is placed into the Foley and secured in place. Next, transanal TME trainees are instructed to attempt to injure the urethra with the aim of identifying the urethra prior to transection by identifying the lighted stent. Under normal laparoscopic light, the stent was not visible, but when the light source was toggled to OFF, the lighted stent (within the urethra) was clearly visible.

In summary, this video demonstrates that the use of a lighted stent within a clear Foley catheter can help visualize the urethra and may prevent inadvertent injury during transanal TME.

References

  1. 1.

    Araujo SE, Crawshaw B, Mendes CR, Delaney CP (2015) Transanal total mesorectal excision: a systematic review of the experimental and clinical evidence. Tech Coloproctol 19:69–82

  2. 2.

    Atallah S (2015) Transanal total mesorectal excision: full steam ahead. Tech Coloproctol 19:57–61

  3. 3.

    Rouanet P, Mourregot A, Azar CC et al (2013) Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum 56:408–415

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Acknowledgments

The authors received no funding for this study, and the research was not supported by any grants or other funding. Dr. S. Atallah is a paid consultant for Applied Medical, Inc. Dr. M. Albert is a paid consultant for Applied Medical and Surgiquest. Dr. B. Martin-Perez and Dr. J. Drake have no disclosures. Dr. P. Stotland and Dr. S. Ashamalla have no disclosures. Part of this video was filmed during a transanal TME course sponsored by Applied Medical, Inc.

Conflict of interest

None.

Author information

Correspondence to S. Atallah.

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Supplementary material 1 (MOV 215920 kb)

Supplementary material 1 (MOV 215920 kb)

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Atallah, S., Martin-Perez, B., Drake, J. et al. 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 19, 375 (2015) doi:10.1007/s10151-015-1297-2

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Keywords

  • Rectal Cancer
  • Total Mesorectal Excision
  • Unique Approach
  • Foley Catheter
  • Adequate Training