Open Total Mesorectal (TME) for Cancer

This operation primer provides excellent photographic step-by-step guidance to this surgical procedure. It has been designed to describe the operation in the simplest manner possible without over-simplifying the complexities involved. Nodal points are at the core of the operation primer, describing the key surgical steps in detail. This surgical guidebook provides essential reference material for surgeons wishing to improve and update their knowledge in this specific area. The operation primer Open Total Mesorectal Excision for Rectal Cancer is especially intended for those surgeons who wish to familiarize themselves with colorectal surgery procedures. A complete total mesorectal excision (TME) plays a major role in the surgical treatment of rectal cancer as various studies have demonstrated its crucial impact on local recurrence rate and survival. Therefore, colorectal surgeons need to be trained in this specific technique. This operation primer is an excellent teaching tool, accurately describing the steps for open total mesorectal excision in a manner suitable for both beginners and experienced surgeons. It provides a detailed overview of patient preparation, key surgical steps, a work up of the resected specimen and common pitfalls of open total mesorectal excision. This operation primer will provide surgeons with a reliable and systematic approach to performing Open Total Mesorectal Excision. Table of contents Introduction.- Structure and handling of the Operation Primer.- Preparations for the operation.- Nodal points.- 1 Incising the skin and the abdominal wall layers.- 2 Exploring the abdominal cavity.- 3 Identifying the anatomical landmarks.- 4 Mobilizing the left lateral sigma and the descending colon.- 5 Mobilizing the splenic flexure.- 6 Dissecting the lymph nodes and the sigmoid mesentery.- 7 Dividing the inferior mesenteric vessels.- 8 Dividing the proximal colon.- 9 Identifying the hypogastric nerves and dissecting the posterior and lateral mesorectum.- 10 Dissecting the anterior mesorectum.- 11 Dividing the rectum.- 12 Preparing the anastomosis – proximal part.- 13 Preparing the anastomosis – distal part.- 14 Anastomosing colon and rectum.- 15 Verifying the anastomosis.- 16 Placing a protective stoma and closing the abdominal wall layers.- 17 Finishing the operation.- Management of difficult situations and complications.- Appendices.