This Video show the performance of a Transanal Total Mesorectal Excision (TME) with a stapled side to end anastomosis. The video is associated with a special article for the journal Colorectal Disease as well as a Video Vignette in the same journal (onlinelibrary.wiley.com/journal/10.1111/(ISSN)1463-1318).
The editorial can be directly accessed at onlinelibrary.wiley.com/doi/10.1111/codi.12661/abstract
The video vignette can be accessed at onlinelibrary.wiley.com/doi/10.1111/codi.12660/abstract
Synopsis: Low mesorectal dissection can be difficult and we find it helps to do some of the lowermost part of the TME dissection from below using a transanal approach. This also needs some modification of the typical mechanical stapling method in order to allow the standard circular stapling devices to be used.
The transanal approach allows for double purse-string stapling and avoids the cumbersome, technical challenging cross stapling of the distal rectum. The main difficulty with the double purse-string technique is the short length of the center rod of the standard circular stapler devices. This makes it difficult to secure the distal purse-string onto the center rod in preparation for the anastomosis. The 33mm CovidienTM EEATM Haemorrhoid and Prolapse Stapler gun has an extended reach (13.5 cm) of the centre rod which allows for sufficient access to secure the purse-string onto the spindle/rod. While this stapler has proven to be safe for low colorectal joints after the transanal approach, the authors feel that the amount of tissue incorporated into this stapler is excessive. In particular we worry about it incorporating sphincter fibres for truly low stapled anastomoses. We have therefore modified our technique in an effort to use the standard 28/29mm or 31mm circular staplers by using a standard Redivac drain (10 F) as an extension of the centre rod. Here in this video vignette, we detail the use of our technique for a side-to-end double purse-string stapled low anastomosis.
Authors: Roel Hompes, Richard Guy, Oliver Jones, Ian Lindsey, Neil Mortensen, Chris Cunningham.
Departments of Colorectal Surgery, Churchill Hospital, Oxford University Hospitals Oxford, UK.
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