Transanal Laparoscopic TME with Multiport Abdominal Laparoscopy

Abstract

Transanal total mesorectal excision (TME) is a new approach in the treatment of rectal cancer. It has gained popularity in the last years, not only because of the novelty of the surgical technique but because it tries to resolve old problems in rectal surgery. The main advantage of the approach is that the decision of where the rectum is sectioned is made as the first manoeuvre.

Its indications are singularly low-mid-rectal cancer and unfavourable patients but can be expanded to high rectal cancer and other pathologies. One of the differences with laparoscopy or open surgery is that, during these approaches, the surgeon is working in a reduced space in the pelvis, and in addition to this, the same area is occupied by the rectum, so it is a really small space. In transanal TME, the surgeon is performing the dissection “down-to-up”, winning space to work, so the view is better, the dissection of the anterior side is better than from above and especially, in difficult cases, you have the perception of a false wider pelvis, just because the rectum is retracted cranially. Transanal TME represents a new approach to perform an old technique.