Single-team transanal total mesorectal excision for mid and lower rectal cancer: Snow Leopard approach

Farag, Ahmed F. A.; Abdelhamid, M. S; El Shafie, Mohammed M.; Mostafa, Mahmoud; Ibrahim, Abulfetouh M.; Abdallah, Abdallah B.; Ammar, S. A.; Elbarmelgi, Mohamed Y.; Daoud, Sahar A.; Lotfallah, Israa M.; Abdelmawla, Mohamed H.

doi:10.4103/ejs.ejs_135_23

Single-team transanal total mesorectal excision for mid and lower rectal cancer: Snow Leopard approach

Authors

Abstract

Background
Transanal total mesorectal excision (TaTME) is a recently developed technique to overcome difficulties of rectal cancer resection spatially in male patients, large tumors, high body mass index, and low rectal cancer.
Methods
From April 2018 to March 2021, 30 patients were included. Single-team TaTME was done, using traditional Laparoscopic instruments and a two-dimensional HD camera, starting with the abdominal phase. The analysis focused on operative data and short-term surgical outcomes.
Results
30 taTME procedures were performed, 16 (53.3%) males and 14 (47.7%) females, with a mean age of 50.43 years. There were 21 (70%) patients with tumors in the middle part of the rectum and 9 (30%) patients with tumors in the low rectum. All patients received Long Course Neoadjuvant CRT. The duration of hospital stay was 5.27±1.08 days. The median operative time was 135.27 min the estimated blood loss was 133.67 66.59 ml. Complete mesorectal excision was achieved in all patients. Circumferential radial margin (CRM) was negative in all cases. 1 (3.3%) case needed conversion to an open approach. The overall postoperative complications rate was 6.6% (2 cases). Postoperative ileus occurred once, and anastomotic leakage occurred in one patient.
Conclusions
In experienced hands, TaTME is a safe technique but still a challenging procedure. The author suggest that single team approach is not time-consuming (operative time was less than what had been reported by other authors using the two-team approach), and dissection should be done through the proper plane (TME planes) lateral to the urosacral ligament in females and its analog in males named prostatosacral ligament as described in the Paper to minimize the incidence of local recurrence.

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