title: Optimal dissection for transanal total mesorectal excision using modified CO2 insufflation and smoke extraction.
abstract: OBJECTIVE
  The new approach of transanal total mesorectal excision is technically challenging and demands a stable field of dissection with optimal view of anatomical landmarks. We aimed to describe and demonstrate a modification of both the insufflation of carbon dioxide and smoke evacuation, in order to optimize dissection.
  
  
  METHODS
  The comparison of standard insufflation to an AirSeal platform demonstrates a clear difference. This is shown in the accompanying video-recordings.
  
  
  RESULTS
  A more stable pneumorectum and better smoke evacuation as well as more convenient and precise dissection were achieved with the AirSeal platform.
  
  
  CONCLUSIONS
  Using the technique outlined, the operating surgeon is able to perform the surgical dissection in a stable operating environment with increased visibility compared to the standard approach.
authors.affiliation: Department of Colorectal Surgery, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: G
authors.initials: G
authors.lastname: Nicholson
authors.affiliation: Department of Visceral Surgery, Jessa Hospital, Hasselt, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Knol
authors.affiliation: Department of Visceral Surgery, Jessa Hospital, Hasselt, Belgium.
authors.forename: B
authors.initials: B
authors.lastname: Houben
authors.affiliation: Department of Colorectal Surgery, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: C
authors.initials: C
authors.lastname: Cunningham
authors.affiliation: Department of Colorectal Surgery, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: S
authors.initials: S
authors.lastname: Ashraf
authors.affiliation: Department of Colorectal Surgery, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: R
authors.initials: R
authors.lastname: Hompes
mesh_terms: D001003:Anal Canal; D002245:Carbon Dioxide / Q000008:administration & dosage*; D004210:Dissection / Q000379:methods*; D006801:Humans; D007327:Insufflation / Q000379:methods*; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012906:Smoke
chemical_list: D012906:Smoke; D002245:Carbon Dioxide
keywords: Total mesorectal excision; airseal; laparoscopy; single port; transanal TME