Live surgeryOctober 6, 20242:19:578 speakersAvailable in: EN / IT
Laparoscopic TME with transanal single stapled anastomosis (TTSS) for low rectal cancer
Live surgery of laparoscopic TME with transanal transition and single stapled anastomosis (TTSS) in a man with low rectal cancer after TNT, with ICG assessment.
Free content for members
Sign in to watch this episode
Full surgical procedures, chapter-marked discussions, and bilingual transcripts — all free for registered members.
Full episodes, chapters, and case framing
Bilingual transcripts (IT / EN)
Save favorites and resume where you left off
Clinical case
Adenocarcinoma del retto basso ulcerato circonferenziale a 7 cm
Patient framing as discussed at case introduction
SexM
Age54
StageLocalmente avanzato con linfoadenopatie pretrattamento e MVI massivo
DiagnosisAdenocarcinoma del retto basso ulcerato circonferenziale a 7 cm
Prior treatmentTNT: induzione con FOLFIRINOX seguita da radiochemioterapia (50 Gy in 25 sedute + capecitabina); ristadiazione a 6 settimane con buona risposta
NotesIntervallo radioterapia-chirurgia 10-12 settimane; programma chirurgico TME + TTSS con ileostomia di protezione
Overview
Episode of the ICG-School Live Surgery 2024 dedicated to the TTSS (Trans-anal Trans-section and Single Stapled anastomosis) technique, performed by Antonino Spinelli on a 54-year-old man with locally advanced low rectal adenocarcinoma (7 cm), treated with total neoadjuvant therapy (TNT) consisting of FOLFIRINOX induction followed by chemoradiotherapy with capecitabine (50 Gy in 25 fractions), with a good clinical response on restaging.\n\nThe procedure, performed with the new Stryker 1788 platform, includes a complete standardized laparoscopic TME with a 5-trocar star configuration, division of the mesenteric vessels at their origin without preservation of the left colic artery, complete default mobilization of the splenic flexure, and meticulous mesorectal dissection down to the pelvic floor. The distinctive part is the transanal transition at the anorectal junction (1 cm above the dentate line) with creation of a purse-string suture and a colo-anal single stapled anastomosis (31 anvil, 34 circular stapler) performed by withdrawing the stump rather than pushing it forward. Perfusion of the proximal colon is checked with indocyanine green. A protective ileostomy is fashioned (standard in male patients after TNT) without drain placement.\n\nThe discussion, moderated by Luca Quarti with contributions from Alberto Arezzo and Gian Luca Baiocchi, addresses the philosophy of true TME vs goal-directed TME, the comparison between TTSS and TATME (with reference to the experience of John Marks and Giorgio Bianchi/Marks in Philadelphia), the use of energy devices vs monopolar for respecting anatomical planes, the usefulness of 0° vs 30° scopes, the prospects of the Da Vinci Single Port robot in colorectal surgery, artificial intelligence for tissue recognition, and the international TTSS registry with over 800 cases collected.
Topics
TTSS technique (Trans-anal Trans-section Single Stapled)
Laparoscopic TME for low rectal cancer
Total neoadjuvant therapy (TNT): induction vs consolidation
Comparison of TTSS vs TATME vs Double Stapled
Standard splenic flexure mobilization
High vs low ligation of inferior mesenteric vessels
ICG fluorescence for colonic perfusion assessment
Transanal purse-string suture and prevention of spiralization
