Transanal total mesorectal excision: dissection tips using 'O's and 'triangles'.
OBJECTIVE
Transanal total mesorectal excision (taTME) requires specific technical expertise, as it is often difficult to ascertain the correct dissection plane. Consequently, one can easily enter an incorrect plane, potentially resulting in bleeding (sidewall or presacral vessels), autonomic nerve injury and urethral injury. We aim to demonstrate specific visual features, which may be encountered during surgery and can guide the surgeon to perform the dissection in the correct plane.


METHODS
Specific features of dissection in the correct and incorrect planes are demonstrated in the accompanying video.


RESULTS
The 'triangles' created using appropriate traction can aid in performing a precise dissection in the correct plane. Recognition of features described as 'O's can alert surgeons that they are entering a new fascial plane and can avoid incursion into an incorrect plane.


CONCLUSIONS
Understanding and recognizing the described features which can be encountered in taTME surgery, a safe and accurate TME dissection can be facilitated.
Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia. mpbernardi16@gmail.com.
M-P
MP
Bernardi
Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
A L A
AL
Bloemendaal
Florida Hospital Orlando, Winter Park, Orlando, FL, USA.
M
M
Albert
Providence Portland Medical Center, Portland, OR, USA.
M
M
Whiteford
Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.|University of Queensland, Brisbane, QLD, Australia.
A R L
AR
Stevenson
Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
R
R
Hompes
D059925:Anatomic Landmarks / Q000601:surgery*; D017776:Autonomic Pathways / Q000293:injuries / Q000601:surgery; D016063:Blood Loss, Surgical / Q000517:prevention & control; D004210:Dissection / Q000009:adverse effects / Q000379:methods*; D005205:Fascia / Q000033:anatomy & histology* / Q000293:injuries; D000071938:Fasciotomy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008646:Mesocolon / Q000033:anatomy & histology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D012007:Rectum / Q000033:anatomy & histology / Q000601:surgery; D012447:Sacrum / Q000294:innervation / Q000601:surgery; D000067368:Transanal Endoscopic Surgery / Q000009:adverse effects / Q000379:methods*; D014521:Urethra / Q000293:injuries / Q000601:surgery
Total mesorectal excision; Transanal TME; ‘O’sand ‘triangles’
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