Techniques in Coloproctology

, Volume 19, Issue 11, pp 679–684 | Cite as

Image-guided real-time navigation for transanal total mesorectal excision: a pilot study

  • S. AtallahEmail author
  • B. Martin-Perez
  • S. Larach
Original Article



Frameless stereotaxy for real-time, image-guided surgery has been most utilized for neurological and orthopedic surgery. Recently, our center has reported the application of real-time navigation for transanal total mesorectal excision.


During a 5-month period (June 2013–October 2013), three male patients underwent transanal minimally invasive surgery for total mesorectal excision with image-guided real-time navigation during the transanal portion of the operation. This was completed using a frameless stereotactic navigational system as shown in a demonstration video. Male patients with anterior, locally advanced rectal cancer were selected for enrollment into the pilot study.


Three male patients (mean age 69) underwent transanal total mesorectal excision with stereotactic navigation during a 5-month study period. Mean operative time was 402 min, and there were no intra-operative complications recorded. The mean distance from anal verge of the tumor was 6.3 cm (range 4–8 cm). The navigational accuracy was computed to be ±3.69 mm (range ±3.20 to ±4.02 mm). The average navigation setup time was 47 min, not including scan time. The surgical specimens were found to have completely intact mesorectal envelopes (Quirke 3) in all cases. All margins, including radial and distal margins, were negative. Mean postoperative length of stay was 5 days. At a median of 18-month follow-up, there was no evidence of locoregional recurrence or distant metastatic disease.


This is the first pilot series to report the use of frameless stereotactic navigation for TAMIS-TME. Stereotactic navigation for transanal total mesorectal excision is shown to be feasible, and may aid in providing colorectal surgeons with the ability to better perform safe, high-quality surgery in select cases.


Transanal TME TAMIS-TME taTME Navigation Stereotaxy Rectal cancer 


Conflict of interest

The authors declare that they have no conflict of interests. 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. B. Martin-Perez and S. Larach have no disclosures.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

Supplementary material 1 (MOV 429000 kb)


  1. 1.
    Mezger U, Jendrewski C, Bartels M (2013) Navigation in surgery. Langenbecks Arch Surg 398:501–514PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Wirtz CR, Albert FK, Schwaderer M et al (2000) The benefit of neuronavigation for neurosurgery analyzed by its impact on glioblastoma surgery. Neurol Res 22:354–360PubMedGoogle Scholar
  3. 3.
    Wixson RL, MacDonald MA (2005) Total hip arthroplasty through a minimal posterior approach using imageless computer-assisted hip navigation. J Arthroplasty 20:51–56CrossRefPubMedGoogle Scholar
  4. 4.
    Atallah S, Nassif G, Larach S (2015) Stereotactic navigation for TAMIS-TME: opening the gateway to frameless, image-guided abdominal and pelvic surgery. Surg Endosc 29:207–211CrossRefPubMedGoogle Scholar
  5. 5.
    Atallah S, Albert M, DeBeche-Adams T, Nassif G, Polavarapu H, Larach S (2013) Transanal minimally invasive surgery for total mesorectal excision (TAMIS-TME): a stepwise description of the surgical technique with video demonstration. Tech Coloproctol 17:321–325CrossRefPubMedGoogle Scholar
  6. 6.
    Araujo SE, Crawshaw B, Mendes CR, Delaney CP (2015) Transanal total mesorectal excision: a systematic review of the experimental and clinical evidence. Tech Coloproctol 19:69–82CrossRefPubMedGoogle Scholar
  7. 7.
    Atallah S (2015) Transanal total mesorectal excision: full steam ahead. Tech Coloproctol 19:57–61CrossRefPubMedGoogle Scholar
  8. 8.
    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 56:408–415CrossRefPubMedGoogle Scholar
  9. 9.
    Mårvik R, Langø T, Tangen GA et al (2004) Laparoscopic navigation pointer for three-dimensional image-guided surgery. Surg Endosc 18:1242–1248CrossRefPubMedGoogle Scholar
  10. 10.
    Kohan D, Jethanamest D (2012) Image-guided surgical navigation in otology. Laryngoscope 122:2291–2299CrossRefPubMedGoogle Scholar
  11. 11.
    Herline A, Stefansic JD, Debelak J, Galloway RL, Chapman WC (2000) Technical advances toward interactive image-guided laparoscopic surgery. Surg Endosc 14:675–679CrossRefPubMedGoogle Scholar
  12. 12.
    Herline AJ, Stefansic JD, Debelak JP et al (1999) Image-guided surgery: preliminary feasibility studies of frameless stereotactic liver surgery. Arch Surg 134:644–649 (discussion 649–650)CrossRefPubMedGoogle Scholar
  13. 13.
    Lamadé W, Vetter M, Hassenpflug P, Thorn M, Meinzer HP, Herfarth C (2002) Navigation and image-guided HBP surgery: a review and preview. J Hepatobiliary Pancreat Surg 9:592–599CrossRefPubMedGoogle Scholar
  14. 14.
    Culligan K, Walsh S, Dunne C et al (2014) The mesocolon: a histological and electron microscopic characterization of the mesenteric attachment of the colon prior to and after surgical mobilization. Ann Surg 260:1048–1056CrossRefPubMedGoogle Scholar
  15. 15.
    Coffey JC, Sehgal R, Culligan K et al (2014) Terminology and nomenclature in colonic surgery: universal application of a rule-based approach derived from updates on mesenteric anatomy. Tech Coloproctol 18:789–794CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia Srl 2015

Authors and Affiliations

  1. 1.Florida HospitalWinter ParkUSA

Personalised recommendations