Novel technique with the IRIS U kit to prevent urethral injury in patients undergoing transanal total mesorectal excision.

Toshikatsu Nitta,Keitaro Tanaka,Masatsugu Ishii,Junji Okuda,Jun Kataoka,Takashi Ishibashi,Masato Ohta

doi:10.1016/j.amsu.2019.08.002

Abstract

BackgroundLow anterior resection of the rectum with total mesorectal excision (TME) has been the gold standard for the surgical treatment of rectal cancer as it has the lowest recurrence rates. The key issue while performing transanal TME (TaTME) is avoiding iatrogenic urethral injury. We introduce our surgical technique for TaTME.Surgical techniqueIntraurethral indocyanine green injection using the IRIS U kit with subsequent visualization under NIR was safely utilized during the TaTME. We were able to easily detect and visualize the IRIS urethral kit. The prostatic segment of the urethra can be identified in real-time using the infrared illumination system urethral kit (IRIS U kit).BenefitsThe prostatic segment of the urethra was easily and quickly identified by the green fluorescence during TaTME.ConclusionOur TaTME technique is an easy and feasible approach that provides real-time urethral images.

Highlights

Low anterior resection of the rectum with total mesorectal excision (TME) has been the gold standard for the surgical treatment of rectal cancer as it has the lowest recurrence rates [1]
transanal TME (TaTME) has become a popular method for the treatment of lower rectal cancer
Urethral injury is a significant complication of TaTME because the dissection line of TaTME is close to the urethra

Summary

Introduction

Low anterior resection of the rectum with total mesorectal excision (TME) has been the gold standard for the surgical treatment of rectal cancer as it has the lowest recurrence rates [1]. We have introduced a new device, the IRIS U kit for transanal TaTME, to help surgeons avoid urethral injury. The key issue while performing TaTME is avoiding iatrogenic urethral injury. This complication is sex-specific, because the urethra of male patients is close to the detachment plane of the rectum, especially in its lower urinary tract segments. A urethral catheter with a guide wire was inserted into the urethra under fluoroscopic guidance, after which the Abbreviations:transanal total mesorectal excision, TaTME ⁎ Corresponding author. There were no complications attributable to IRIS U kit use

The convalescence was unremarkable postoperatively

Results

Discussion

Ethical approval

Conflicts of interest