The Máxima Medical Centre (MMC) is introducing a new keyhole surgery that allows rectal tumours - tumours in the last part of the colon - to be removed much more accurately than with other techniques. Also, in many cases, the operation makes it possible to spare the anus and avoid having to wear a stoma. It involves 'Transanal Total Mesorectal Excision' (TaTME), which involves surgery through a flexible working channel in the rectum - a transanal access port - using 'standard' endoscopic instruments.
In a third of patients with colon cancer, the tumour is present in the last part of the colon: the rectum. Previously, these tumours were removed using minimally invasive surgery, in which a few small incisions were made in the abdomen.
Complex surgery
"It involves a complex procedure. Until now, we operated through a few incisions in the abdomen. However, the bend in the intestine is difficult to make with surgical instruments and it is a small area to operate in. It is difficult not to damage other tissue then," explains Frank van den Broek, lung surgeon, surgeon-oncologist and gastrointestinal surgeon at Máxima Medical Centre.
TaTME offers a solution. This operation involves two surgical teams working towards each other. One team performs laparoscopic resection, which involves surgery through small incisions in the abdominal cavity. The other team operates through the anus using endoscopic instruments. Because in TaTME, surgery is performed through the anus, the rectum can be reached more easily. This allows more precise removal of the tumour including surrounding fatty tissue and lymph nodes.
More precise surgery
"With the new technique, surgery is performed through the anus and we are much closer to the tumour. We can operate more precisely, which means we can remove the tumour more precisely and damage the healthy tissue less. This technique is therefore the new standard for us," Van den Broek said.
With the technique previously used to remove rectal tumours, it was often not possible to spare the pelvic floor muscles and sphincter muscle. In this case, the patient had to wear a stoma. This is unnecessary in many cases when TaTME is applied. Van den Broek: "We can operate much lower in the bowel than before. Not always, but in many cases we can now spare the anus. Having a stoma is a bugbear for many patients, fortunately we don't have to put one on as often now."
Used in a few hospitals worldwide
Hospital Gelderse Vallei reports that TaTME was developed by Colin Sietses, a colon-liver surgeon who has operated at Hospital Gelderse Vallei since 2008. The technique was first published in 2014. The technique is used in a few hospitals worldwide, including Gelderse Vallei Hospital and the VUmc. Surgeons from MMC, under the guidance of surgeons from VUmc, recently opened the first patients with this surgical technique.
Author: Wouter Hoeffnagel
Source: VUmc
Source: Gelderse Vallei hospital
Source photo: Pixabay / terepiedrahitag
