TaTME Procedure

SET up;

  • Bowel preparation
  • Profylactic antibiotics
  • Lithotomy, both arms alongside
  • Rectal lavage on table with betadine
  • Equipment set up for abdominal and transanal phase

 

Abdominal phase; mobilisation

  • Splenic flexure take down  from medial to lateral (optional step, tailored  option) Including ligation of the mesenteric inferior vene
  • Medial to lateral sigmoid mobilization
  • Identification of the right plane, sure well above ureter
  • Ligation of the IMA just above hypogastric plexus (sparing left colic artery)

 

Abdominal phase rectal dissection

  • Circumferential perirectal incision of the peritoneum
  • Anterior dissection just until vesicles; denonvillier is spared if oncological safe
  • Posterior the first one third of the TME plane
  • Lateral identification of the hypogastric nerve bundle; medial to bundle dissection

 

Transanal part ; Ten COMMANDS

  1. Identification anatomical landmarks; urethra, oscoccygus, length of internal sphincter
  2. Lone starr application with 8 elastic retractors
  3. Port insertion (gelpoint)
  4. Laparoscopic or open pursestring
  5. TAMIS step 1 circumferential full thickness incision
  6. TAMIS step 2 posterior TME plane identification
  7. TAMIS stap 3 anterior right plane behind prostate
  8. TAMIS stap 4 lateral plane identification
  9. TAMIS stap 5 connection with abdominal phase
  10. TAMIS stap 6 specimen extraction (transanal of abdominal)
  11. TAMIS stap 6 anastomosis (doublepurse string, stapled )
    1. 4 types anastomosis
      1. Coloanal intersphincteric
      2. Stapled hemorroidal stapler
      3. Stapled 28-29 mm; abdominal exposure and stapling (drain method)
      4. Stapled 28-29 mm; transanal exposure and stapling (wired method)