Abdominal phase:
- Da Vinci surgical system docking
- Inferior mesenteric vessels division
- Left colon mobilization
- High mesorectal dissection
- “Rendez-vous” with the transanal team
- Colostomy creation.
Transanal phase:
- Endoscopic platform introduction and placement of laparoscopic instruments, including a flexible tip 3D camera
- Closure of the rectal lumen and flood with cytocidal solution
- Rectotomy with electrocautery
- “Down-to-up” TME acute and circumferential dissection
- “Rendez-vous” with the abdominal team
- Specimen extraction
Learning Points:
- How to perform a combined two-tea, Cecil approach with the robotic surgical system
- The advantages of the robotic assistance during TaTME for rectal cancer
- Tips and tricks to perform the low pelvis dissection
- Which are the new complications that may arise during TaTME
Technical Investigations:
- 83-year-old man.
- Cardiac failure.
- COPD stage IV.
Clinical Case:
- Rectal bleeding.
- Colonoscopy:
- Tumour 10 cm from the anal verge.
- Polypoid lesion 3 cm from the anal verge.
- Pathology: adenocarcinoma.
- CT, pelvic MRI and endoanal ultrasound: T3N0M0.
- Faecal incontinence: endoanal manometry.
- Blood test
- TAMIS of the polypoid lesion. Pathology: villous adenoma.
83-year-old man with a medical history of dilated cardiac failure and COPD stage IV. The patient came to the outpatient clinic with a history of rectal bleeding and a colonoscopy was performed showing a tumor 10 cm from the anal verge and a 25-35mm polypoid lesion 3 cm from the anal verge. The rectal tumor 10 cm from the anal verge was staged as a T3N0M0 adenocarcinoma after A CT scan, pelvic MRI and endoanal ultrasound.
The patient described fecal incontinence which was confirmed by the endoanal manometry.
The blood test showed a CEA of 7.5 and Hb of 10.9.
Due to the presence of the rectal polyp 3 cm from the anal verge, a TAMIS was performed with Pathology showing a villous adenoma with no signs of malignancy.
Anterior rectal resection was proposed 20 days after TAMIS.
