Navigation for Transanal Total Mesorectal Excision

  • Luis Gustavo Capochin Romagnolo
  • Arthur Randolph Wijsmuller
  • Armando Geraldo Franchini Melani


Functional and oncological outcome after multimodal treatment for rectal cancer could be improved. This can be achieved with a better recognition of anatomical dissection planes, of anatomical landmarks, and of the dissection margin to the tumor to optimize resection margins and to minimize iatrogenic nerve damage. Recently, the performance of stereotactic navigation for minimally invasive transanal rectal surgery has been reported. Additionally, critical challenges related to soft-tissue stereotactic pelvic navigation were assessed. Surgical navigation systems could improve the quality of surgery for rectal cancer as shown when used in other contexts. It is likely to improve the accuracy and efficiency of pelvic surgical procedures in which it is difficult or impossible to identify and dissect along anatomical planes.


Rectal cancer taTME Navigation system Pelvic surgery GPS intraoperative 



The authors want to thank Bernard Dallemagne for his guidance during the projects leading up to this chapter. We also thank Guy Temporal and Chris Burel for their editorial assistance.


  1. 1.
    Atallah S, Martin-Perez B, Larach S. Image-guided real-time navigation for transanal total mesorectal excision: a pilot study. Tech Coloproctol. 2015;19(11):679–84.CrossRefGoogle Scholar
  2. 2.
    Atallah S, Nassif G, Larach S. Stereotactic navigation for TAMIS-TME: opening the gateway to frameless, image-guided abdominal and pelvic surgery. Surg Endosc. 2015;29(1):207–11.CrossRefGoogle Scholar
  3. 3.
    Wijsmuller AR, et al. Advances in stereotactic navigation for pelvic surgery. Surg Endosc. 2018;32(6):2713–20.CrossRefGoogle Scholar
  4. 4.
    Lange MM, et al. Urinary dysfunction after rectal cancer treatment is mainly caused by surgery. Br J Surg. 2008;95(8):1020–8.CrossRefGoogle Scholar
  5. 5.
    Lange MM, et al. Risk factors for sexual dysfunction after rectal cancer treatment. Eur J Cancer. 2009;45(9):1578–88.CrossRefGoogle Scholar
  6. 6.
    Wallner C, et al. Causes of fecal and urinary incontinence after total mesorectal excision for rectal cancer based on cadaveric surgery: a study from the Cooperative Clinical Investigators of the Dutch total mesorectal excision trial. J Clin Oncol. 2008;26(27):4466–72.CrossRefGoogle Scholar
  7. 7.
    van der Pas MH, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14(3):210–8.CrossRefGoogle Scholar
  8. 8.
    Guillou PJ, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365(9472):1718–26.CrossRefGoogle Scholar
  9. 9.
    Kang SB, et al. Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial. Lancet Oncol. 2010;11(7):637–45.CrossRefGoogle Scholar
  10. 10.
    Fleshman J, et al. Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA. 2015;314(13):1346–55.CrossRefGoogle Scholar
  11. 11.
    Stevenson AR, et al. Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA. 2015;314(13):1356–63.CrossRefGoogle Scholar
  12. 12.
    Deijen CL, et al. COLOR III: a multicentre randomised clinical trial comparing transanal TME versus laparoscopic TME for mid and low rectal cancer. Surg Endosc. 2016;30(8):3210–5.CrossRefGoogle Scholar
  13. 13.
    Buchs NC, et al. Transanal total mesorectal excision: a valid option for rectal cancer? World J Gastroenterol. 2015;21(41):11700–8.CrossRefGoogle Scholar
  14. 14.
    Rouanet P, et al. Transanal endoscopic proctectomy: an innovative procedure for difficult resection of rectal tumors in men with narrow pelvis. Dis Colon Rectum. 2013;56(4):408–15.CrossRefGoogle Scholar
  15. 15.
    Mezger U, Jendrewski C, Bartels M. Navigation in surgery. Langenbeck’s Arch Surg. 2013;398(4):501–14.CrossRefGoogle Scholar
  16. 16.
    Wadley J, et al. Pre-operative planning and intra-operative guidance in modern neurosurgery: a review of 300 cases. Ann R Coll Surg Engl. 1999;81(4):217–25.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Kawada K, et al. Stereotactic navigation during laparoscopic surgery for locally recurrent rectal cancer. Tech Coloproctol. 2017;21(12):977–8.CrossRefGoogle Scholar
  18. 18.
    Atallah S, Tilahun Y, Monson JR. Real-time stereotactic navigation for the laparoscopic excision of a pelvic neoplasm. Tech Coloproctol. 2016;20(8):599–600.CrossRefGoogle Scholar
  19. 19.
    Wijsmuller AR, et al. A step towards stereotactic navigation during pelvic surgery: 3D nerve topography. Surg Endosc. 2018;32(8):3582.CrossRefGoogle Scholar
  20. 20.
    Guerriero L, et al. Virtual reality exploration and planning for precision colorectal surgery. Dis Colon Rectum. 2018;61(6):719–23.CrossRefGoogle Scholar
  21. 21.
    Franchini Melani AG, Diana M, Marescaux J. The quest for precision in transanal total mesorectal excision. Tech Coloproctol. 2016;20(1):11–8. Epub 2015 Nov 26.
  22. 22.
    Atallah S. The dawn of the digital operating theatre and the rise of the digital surgeon. Tech Coloproctol. 2015;19(9):499–501. Epub 2015 Jun 17.

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Luis Gustavo Capochin Romagnolo
    • 1
    • 2
  • Arthur Randolph Wijsmuller
    • 3
  • Armando Geraldo Franchini Melani
    • 1
    • 4
  1. 1.IRCAD Latin AmericaBarretosBrazil
  2. 2.Department of SurgeryBarretos Cancer HospitalBarretosBrazil
  3. 3.Department of SurgeryUniversity Medical Center GroningenGroningenThe Netherlands
  4. 4.Americas Medical CityRio de JaneiroBrazil

Personalised recommendations