Video Article Research Articles

“Self-oscillating” Polymer Gels Beating like a Heart Cell as Biomimetic and Smart Softmaterials

Video Article Open Access “Self-oscillating” Polymer Gels Beating like a Heart Cell as Biomimetic and Smart Softmaterials Ryo Yoshida Department of Materials Engineering, School of Engineering, The University of Tokyo, Hongo 7-3-1, Tokyo 113-8656, Japan Vid. Proc. Adv. Mater., Volume 1, Article ID 2020-0838 (2020) DOI: 10.5185/vpoam.2020.0838 Publication Date (Web): 10 Nov 2020 Copyright © IAAM Abstract PDF

Robotic-Assisted Laparoscopic Repair of Post-Hysterectomy Vesicovaginal Fistula Using Omental Interposition Flap

Study ObjectiveTo demonstrate, via robotic-assisted laparoscopy, a transperitoneal technique for repair of post-hysterectomy vesicovaginal fistula (VVF) using an omental interposition flap.DesignVideo article.SettingUniversity Hospital and referral center for Gynaecological disease.Patients or ParticipantsA 52-year-old woman with VVF after laparoscopic hysterectomy.InterventionsRepair of post-hysterectomy VVF with omental flap interposition.Measurements and Main ResultsA 52-year-old woman with a history of menorrhagia refractory to medical treatment underwent a total laparoscopic hysterectomy and bilateral salpingectomy. Histology of the uterus showed multiple uterine fibroids and adenomyosis. Twelve days following the hysterectomy, she developed leakage of urine per vagina. Computed tomography scan and cystourethrogram demonstrated normal ureters and presence of a vesicovaginal fistula. An indwelling catheter was inserted to rest the bladder and allow the acute inflammation surrounding the fistula to subside prior to definitive surgical repair six weeks later. The repair consisted of seven steps:1.Restoration of anatomy2Opening the vaginal vault3Identification of fistula defect4Resection of fistula tract5Dissection of vesicovaginal space6Closure of vesical and vaginal defects7Interposition of omental graftThe patient was discharged 48 hours after surgery. The indwelling catheter was maintained for 14 days. Cystourethrogram was carried out to confirm the integrity of the bladder prior to catheter removal. There was no further vaginal loss. Clinical follow up at six weeks and three months post-repair showed no bladder or vaginal dysfunction.ConclusionRobotic-assisted laparoscopy is a feasible approach for repair of VVF, which can be performed systematically using seven steps. This technology lends itself well to procedures requiring intricate dissection and multi-layered suturing as demonstrated in this case.

The Bermuda`s Triangle a Didactic Description of the Retroperitoneal Anatomy

Study Objective The objective of this video is to teach an ¨effective¨ technique to find and clip the uterine arteries, previous to a total laparoscopic hysterectomy (TLH). Design video article. Setting Private Hospital. Patients or Participants N/A Interventions Hysterectomy is one of the most common surgical procedures around the world; Just in the USA, around 600,000 procedures are done yearly. The total laparoscopic hysterectomy has become one of the most common used techniques. According to the actual literature, the complication rate is in the range of 5.7/1000 procedures and bleeding is one of the most stressful complication. The purpose of this video article is to describe ¨The Bermuda´s Triangle¨ a very didactic description of the retroperitoneal vascular anatomy; With this description, it will be extremely easy to find and clip the uterine arteries, before performing a total laparoscopic hysterectomy. We named The Bermuda`s Triangle, because on the Atlantic Ocean the Bermuda's triangle is one of the most enigmatic and scare places, the same happened with the retroperitoneal space With the uterine arteries occluded, we decrease the uterine blood supply by 79%. After the initial anatomic pelvic inspection, we will see the pelvic side wall, we can draw an inverted triangle, that is formed from the superior side by utero-ovaric ligament, from the inferior side by the ureter and from the external side from the IP ligament, at the middle of the triangle we are gaining access into the retroperitoneal space; it will be quite easy to identify the vascular structures, nerves and ureter. The internal iliac artery will be identified, giving a bifurcation into uterine artery and superior vesical artery. The titanium clips are placed on the uterine artery. Measurements and Main Results N/A Conclusion The uterine arteries are clipped at the base, in an extremely easy and safe style. Doing this, we are decreasing the chances of a hemorrhage.

Virtual Laparoscopic Skills Training Guide for FLS (Fundamentals of Laparoscopic Surgery)

Study Objective The objective of this video is to provide an example of how to teach laparoscopic skills, specifically FLS (fundamentals of Laparoscopic Surgery) virtually and remotely. Design This is an educational video. Institutional review board approval was not required for this video article as the video does not describe a clinical case but rather laparoscopic simulation. Setting Academic teaching hospital. Patients or Participants Gynecologic surgery trainees. Interventions The video demonstrates how to set up a portable laparoscopic trainer box for mobile devices and provides tips and tricks to optimize a virtual platform for teaching FLS (Fundamentals of Laparoscopic Surgery). Measurements and Main Results The key elements for successful implementation of virtual laparoscopic skills training include accessibility to low-cost portable laparoscopic trainers, a mobile device and a virtual platform. Conclusion Tele-simulation for laparoscopic skills training is feasible and cost-effective.

Twitter for the Gynecologist

Study Objective The objectives of this video are to: 1) review the importance of Twitter for gynecologists, 2) demonstrate how to create a Twitter account, and 3) describe how to effectively utilize the Twitter platform professionally. Design This is an educational video. Institutional review board approval was not required for this video article as the video describes the impact and use of Twitter and does not describe a clinical case. Animations were created by the authors. Setting Twitter as a social media platform. Patients or Participants Gynecologists. Interventions Through the use of animation and examples, the video describes how to use Twitter to: 1) be a voice for the medical community, 2) educate and inform patients and other medical professionals, 3) network and collaborate with colleagues and experts in the field, 4) stay up to date on clinical information remotely, and 5) market and brand oneself as a gynecologist. Measurements and Main Results The video can serve as a resource for gynecologists to learn how to create a twitter account and understand how to leverage Twitter for professional use. Conclusion The use of social media is growing, and social media platforms such as Twitter are being utilized ubiquitously in the medical field by patients, healthcare professionals, organizations, and journals to share information and increase visibility. It is imperative as a gynecologist to learn how to utilize Twitter professionally in order to be a voice for the medical community and disseminate evidence-based information.

Mayer-Rokitansky-Küster-Hauser syndrome with rare findings of inferior crossed-fused renal ectopia and Gartner's duct cyst: a video case report

To describe the treatments of a patient using the laparoscopic Davydov's method for Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and ureteral reimplantation for hydronephrosis and hydroureter. Surgical video article. A consent form from the patient was obtained as appropriate; the nature of the study did not necessitate ethics committee approval. There were no conflicts of interest. University hospital. A 28-year-old woman who presented at our gynecology department with the symptoms of primary amenorrhea and difficult intercourse. She had repaired congenital rectovestibular fistula and imperforate anus at the age of 8. At physical examination, she had a phenotypically normal vulva with a vaginal small pouch (0.5 cm). Magnetic resonance imaging of the pelvis revealed normal ovaries, a primordial uterus, absence of vaginal canal, and a 4.0 × 4.2 × 4.0 cm cystic structure posterior to the bladder. Magnetic resonance urography showed right to left renal crossed-ectopia with inferior fusion, and hydronephrosis and hydroureter from the superior kidney with Grade Ⅳ vesicoureteral reflux. Karyotype was 46, XX. Saline solution 300 mL was injected into the rectovesical space with an infusion of diluted adrenaline (1:200,000). The goal of this injection was to aid in the identification of tissue planes and reduce blood loss. The space between urethra/bladder and rectum progressively was dissected. Blunt dissection was performed initially with digital separation of tissues. Then, an 8-cm-long neovaginal vault of about 3 cm in diameter was created. The mobilized peritoneum was pulled downward with eight Vicryl sutures and connected to the vaginal epithelium. By cystoscope, we found the left orifice but could not find the right orifice of the hydroureter. Then we ligated the hydroureter by 2-0 absorbable suture near the cyst and cut off the hydroureter, and then incised of all the layers at the top of the bladder to make a bladder flap. We placed the 5 Fr double J stent in the hydroureter and the bladder and anastomozed with the ureteral stump (3-0 Vicryl). Then we removed the cyst laparoscopically. We performed a purse-string stitch to create the apex of the neovagina by taking posterior serosa of the bladder, the pelvic peritoneum between the ovary and rectum, primordial uterus, and anterior rectal serosa. Measurement of the final canal length, sexual function (Female Sexual Function Index), and degree of hydronephrosis. Three days later, we started to change the vaginal mold and the patient was advised to wear it day and night for the first postoperative month. The vaginal mold had to be worn each night until normal sexual intercourse was possible. Findings confirmed the cyst was Gartner's duct cyst. One year after the surgery, the final canal length was 9 cm and Female Sexual Function Index score was 28. The ultrasound showed that the degree of hydronephrosis of upper moiety was mild. The distal Wolffian ducts in the female are absorbed but may persist as vestigial remnants (Gartner's duct cysts). A few cases of the combined urogenital-Wolffian anomalies are reported; most of them are associated with the anomalies of müllerian duct fusion, such as Herlyn-Werner-Wunderlich syndrome (uterus didelphys, obstructed hemivagina, and mesonephric duct anomalies). The embryogenesis of the combined anomalies is not completely understood. With comprehensive preoperative assessments, laparoscopic surgery could be a safe and effective treatment to these cases.

Fluorescence-guided management of deep endometriosis

To demonstrate the advantages of the fluorescence-guided surgery using indocyanine green (ICG) in the management of deep endometriotic nodules toward more complete and safe excision of the disease in cases when rectal shaving is performed. Surgical video demonstrating the result of the application of a fluorescent dye (ICG) during deep endometriosis surgery. The local institutional review board was consulted and ruled that approval was not required for this video article because the video describes a technique and the patient cannot be identified. Tertiary-care university hospital. The patient underwent rectal shaving due to a deep endometriotic nodule located at the level of the rectovaginal septum. The procedure started with exploration of the lesion and the anatomical structures. The nodule is approached using the "reverse technique." As the nodule is infiltrating the vagina, complete resection of the posterior vaginal wall is performed. At the start of the rectal shaving, ICG is injected and its fluorescence effect is used to provide navigation for the surgeon during the excision. At the end of the procedure the vascularization of the bowel wall and the vagina are evaluated with the help of the ICG. Visual assessment and distinction between the borders of the endometriotic nodule and the rectal wall as a result of the fluorescence effect of the ICG. After injection of the ICG, the borders of the healthy rectum are delineated and a clear distinction between the endometriotic nodule and the bowel wall is demonstrated. In addition, the effect of the ICG was used to assess the vascularization of the infiltrated organs (vagina and rectal wall). Deep endometriosis at the level of the rectum usually represents a solid fibrotic nodule. The fibrosis plays a major role in the development of the disease. Indocyanine green is a fluorescent contrast agent, routinely used in a wide range of specialties to assess the blood supply and vascularization of different organs and tissues. Based on the fibrotic nature of the disease, the fluorescence could facilitate the distinction between healthy vascularized tissues and the endometriotic nodule. In the presented case, using ICG, a clear difference between the nodule and the rectum is demonstrated, as well as the vascularization of the bowel wall and the vagina. The implementation of ICG during endometriosis surgery could provide navigation for the surgeon toward a more complete and safer treatment of the disease, reducing the risk of complications and reinterventions. Additional studies are needed to further evaluate ICG fluorescence-guided surgery in the management of deep endometriosis.

A four step strategy for robot assisted abdominal cerclage placement prior to pregnancy

To demonstrate a simple, stepwise strategy for robot-assisted abdominal cerclage placement before pregnancy. Demonstrative video presentation. Surgical footage surrounding a case report is used to describe a four-step technique for robot-assisted abdominal cerclage placement in women with recurrent pregnancy loss or other anatomic variants before pregnancy. This video article was reviewed by the Investigational Review Board and further investigation was waived because the study was "not considered human subject research." Tertiary medical center. A 38-year-old G4P0220 (Gestations: 4, Term deliveries: 0, Preterm deliveries: 2, Abortions: 2, Living children: 0) with a history of two second trimester losses who had failed a prior history-indicated transvaginal cerclage (Fig. 1). The patient underwent an uncomplicated robot-assisted abdominal cerclage using a four-step strategy: Step 1, create the bladder flap; Step 2, identify pertinent anatomy; Step 3, place the cerclage; and Step 4, hysteroscopy. Intraoperative technique presenting a four-step method to ensure successful robot-assisted abdominal cerclage placement. Robot-assisted abdominal cerclage is a safe, viable alternative to traditional abdominal cerclage placed via laparotomy. This video outlines four critical steps to facilitate placement and decrease patient morbidity. This patient did well operatively without increased blood loss or operative time and was discharged home on postoperative day 1. She went on to have a successful future pregnancy and currently is scheduled for an elective cesarean section at term. Abdominal cerclages significantly improve pregnancy and neonatal outcomes in women who previously have failed transvaginal cerclage. Robot-assisted abdominal cerclage placement allows a minimally invasive approach with enhanced dexterity and better visualization for the surgeon compared with conventional laparoscopy or laparotomy, as well as decreased pain and shorter recovery time for patients. This video demonstrates placement of a robot-assisted abdominal cerclage in a patient with recurrent pregnancy loss using a simple four-step strategy to ensure successful, correct, and easy placement. To our knowledge, this is the first video demonstrating a stepwise approach to robot-assisted abdominal cerclage placement.

Why and how to proceed to an ultrasound-guided transvaginal drainage of tubo-ovarian abscesses (with demonstrative video)?

The treatment of the acute phase of complicated tubo-ovarian abscesses relies on antibiotics associated with surgical management in case of visible abscess, poor clinical tolerance and resistance to medical treatment. Transvaginal, ultrasound-guided, puncture drainage can be considered as an alternative to initial laparoscopy and has multiple advantages over the latter: same success rate, less invasive nature, simple and fast to perform, easy to access, better tolerated by the patient, decreased hospitalization time and less cost. This video article describes and standardizes the essential steps to perform a transvaginal adnexal abscess drainage with a step-by-step explanation of the technique in logical sequences, making the procedure ergonomic and easy to learn. Thus, as part of minimally invasive approach, this technique is henceforth suggested as an effective alternative and signifies a first-line procedure that can promote a therapeutic de-escalation strategy.

Poetics of Relations: A Manifesto on Performance-Based Filmmaking

This video article expands upon the Poetics of Relations, the embodied research of VestAndPage (Verena Stenke and Andrea Pagnes), which informs their performance-based filmmaking theory and practice. Since 2010, the artist duo inquires into the pillars that constitute the cross-contamination of the two art forms of time-based live art and filmmaking. Their films have been produced geo-psychologically in a variety of locations around the world: from the remote regions of Chilean Patagonia and Tierra del Fuego to the Antarctica; from socio-cultural areas of conflict like Kashmir and North-West India to the volcanic island of Formentera; and during a month-long performance walk through Germany, Poland and the Russian exclave of Kaliningrad. Each of the films focuses upon a particular research and artistic subject. In this video article, their film projects are taken under the pinhole to look into what could constitute a manifesto of sorts in which the embodied research process identifies the essentials constituents of their practice, and elaborates on the integration of filming, story, time, space, character, action, objects, text, sound, effects, atmosphere, production and editing.

Vaginal approach in radical vaginal trachelectomy – video article

Summary video vaginal approach in radical vaginal trachelectomy Early-stage cervical cancer often affects young patients seeking parenthood. The combination of laparoscopic pelvic lymphadenectomy and radical vaginal trachelectomy was developed by...

Simplified two-step technique for transvaginal natural orifice transluminal endoscopic surgery

To describe our simplified two-step technique for transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and to demonstrate the application of the technique. Step-by-step description of the technique and demonstration of its application using surgical video footage from two different cases. Tertiary university hospital. Patient 1 was a 27-year-old G0P0 woman who presented with right lower quadrant pain. Transvaginal ultrasound scan revealed a right ovarian torsion. Patient 2 was a 25-year-old G3P2 woman. She presented with vaginal bleeding and left lower quadrant pain. Her serum β-human chorionic gonadotropin level was 28,313 U/L, and transvaginal ultrasound scan revealed an ectopic pregnancy in the left tube. The decision to perform vNOTES was made for both patients. As the first step, patients underwent diagnostic vNOTES. The patient was placed in lithotomy position under general anesthesia. By use of a 5-mm trocar with autoretracting blade, a colpotomy was performed on the posterior vaginal wall. Pneumoperitoneum was achieved, and the patient was placed in a Trendelenburg position. A 5-mm 30° rigid endoscope was introduced, and the diagnosis was confirmed. After the confirmation of the diagnosis, we proceeded to the second step. The colpotomy was enlarged with blunt dissection by using Metzenbaum scissors. A self-constructed pessary port was placed through the colpotomy, and pneumoperitoneum was achieved. The therapeutic procedure was then performed. Patient 1 underwent ovarian detorsion with a 5-mm laparoscopic grasper. After the ovary was detorsioned, a 5-mm bipolar instrument was used to achieve hemostasis. Patient 2 underwent left salpingectomy with a 5-mm advanced bipolar device. Hemostasis was verified, and the specimen was extracted through the colpotomy. Procedures ended with the closure of colpotomy with running resorbable sutures. Description of the technique and demonstration of its applicability in two common gynecological emergencies. Both patients were treated successfully by vNOTES. The operating times were 25 minutes and 38 minutes for patient 1 and patient 2, respectively. Patients were discharged on postoperative day 1 without any complications. Our simplified two-step technique described and demonstrated in this video article is a feasible and practical approach to perform vNOTES. The first step allows the confirmation of the diagnosis and facilitates the colpotomy. The use of the self-constructed pessary port enables to perform surgery with already existing equipment without the need for specialized equipment and without increasing the costs.

Surgery of the pancreatic cystic echinococcosis: a case report

: The prevalence of pancreatic cystic echinococcosis (PCE) is ranging between 0.2% and 0.6%. This video article aimed to present a case of isolated PCE that simulated a mucinous cyst. A 55-year-old man consulted for epigastric pain considered as an acute pancreatitis regarding the high level of lipasemia. The preoperative diagnosis, according to Computed Tomographic scan and magnetic resonance imaging, was pancreatic cyst evoking an Intra ductal Papillary Mucinous Neoplasm. The diagnosis of PCE located in the body and tail was recognized intraoperatively. A spleno distal pancreatectomy (radical surgery) was performed. The main “take away” lesson from this case is that diagnosis of PCE is easy when it is associated with liver CE; it becomes difficult when PCE was isolated simulating other diagnosis. The therapeutic decision depends on the PCE location: conservative surgery for the head of the pancreas and radical surgery for body and/or tail of the pancreas and surgeons should take care for the dissemination of echinococcosis.

Updates in processing of anterior fat pad aspirate for amyloid (with video and sketches).

Fat pad aspiration is a commonly used method for detecting amyloid in tissue. Amyloid is detected in the small blood vessels of the aspirated adipose tissue. Optimum evaluation of amyloid with electron microscopy requires at least 15 blood vessels in the fat pad aspirate. The presence of a significant proportion of adipocytes in the aspirate dilutes the fibrovascular portion. This may compromise the evaluation for amyloid with electron microscopy and in FFPE with proteomic studies by mass spectroscopy for confirmation of the amyloid subtype. This video article describes the updated protocol for processing the anterior fat pad aspirate. It demonstrates how to remove the interference of blood and fatty component in the fat pad aspirate performed by the previously reported procedure.

The Invisible External Cervical Os. Tips and Tricks to Overcome this Challenge during In-Office Hysteroscopy

Hysteroscopy is considered the gold standard technique for the diagnosis and management of intrauterine pathology allowing to "see and treat" patients in 1 session if desired [1-3]. Pain and the inability to enter the uterine cavity are the most common limitations of hysteroscopy, especially when performed in an office setting [4-7]. Cervical stenosis is a common hysteroscopic finding frequently encountered in postmenopausal women, especially in patients with a history of cervical procedures such as cone biopsy [8]. It represents a challenge even for the most expert hysteroscopist. Overcoming the stenosis of the external cervical os is technically more demanding than facing the obliteration of the internal os. The aim of this video article is to illustrate the use of simple techniques that allow the hysteroscopist to safely identify the location of the external cervical os and to overcome the difficulties in entering the uterine cavity during in-office hysteroscopy in patients with severe cervical stenosis including those with complete obliteration of the external cervical os. These techniques are easy to adopt and can be used in different clinical situations in which the hysteroscopic evaluation of the uterine cavity is needed in women with severe cervical stenosis. A series of videos of challenging cases with severe cervical stenosis with complete obliteration of the external cervical os are presented that demonstrate maneuvers to properly identify and enter the cervical canal, unfolding key aspects of the procedure. Tips and tricks to facilitate the adoption of these useful maneuvers into clinical practice are highlighted. In-office diagnostic hysteroscopy was performed using a 5-mm rigid continuous flow operative hysteroscope. Patients were placed in a dorsal lithotomy position. The vaginoscopy "no touch" technique was used [9]. No anesthesia or sedation was administered to any of the patients. Normal saline was used as distention media. Taking advantage of the magnification provided by the hysteroscope, the location of the external cervical os was determined. In cases in which the external cervical os was not clearly recognized, the cervix was gently probed with the use of the uterine palpator, grasper, or scissors (Fig. 1). Recognition of the landmarks of the cervical canal provides reassurance of the adequate identification of the external cervical os and facilitates the use of the correct plane of dissection that leads into the uterine cavity (Fig. 2). Additional maneuvers that are useful to navigate the endocervical canal to overcome stenosis of the internal cervical os are also illustrated. The combination of a delicate technique and operator experience aids in overcoming the challenge of cervical stenosis in an office setting. Adopting the presented tips and tricks to enter the uterine cavity in the presence of severe cervical stenosis will reduce the rate of failed hysteroscopic procedures, decreasing the need to take patients to the operating room and the use of general anesthesia.

Trans-obturator cystocele repair of level 2 paravaginal defect.

It is reported that almost one in five women will need some form of pelvic organ prolapse surgery in their lifetime, with anterior wall repair accounting for nearly half of these. Cystoceles occur secondary to defect(s) in one or more of the vaginal wall support mechanisms, including its lateral paravaginal attachments. Paravaginal defects are very common in women presenting with cystocele, thus highlighting the importance of paravaginal defect repair for optimal cystocele correction in the majority of cases. Although there are several paravaginal defect repair procedures, some entail complex techniques, whereas others rely on the use of transvaginal mesh, which is currently not permitted in many countries. In this video article we present a novel trans-obturator native tissue paravaginal defect repair for the management of cystocele. This procedure has the advantages of avoiding complex transabdominal paravaginal defect repair, the controversial use of transvaginal mesh, or a single-point fixation to an arcus tendineus fasciae pelvis that might be difficult to identify. We believe that the trans-obturator cystocele repair procedure offers several advantages over existing paravaginal defect repair alternatives.

Technical aspects of web device in aneurysm treatment

Wide-neck bifurcation aneurysms (WNBAs) make up 26–36% of all brain aneurysms. Intrasaccular flow disruption is an innovative technique for the treatment of WNBAs. The Woven EndoBridge (WEB) device (Sequent Medical,...

Minimally invasive management of Bartholin gland abscesses (with demonstrative video)

Bartholin gland abscesses are common problems in women and their management represents a mainstay of gynecology. Various treatment methods have been described. We present a technique performed under local anesthesia, without hospitalization or postoperative care. As part of a minimally invasive approach, this procedure promotes therapeutic de-escalation, has high patient acceptance, improves clinical outcomes and reduces costs. The procedure is highlighted through an instructive video article which standardizes the essential steps, to make the technique ergonomics and easy to perform (step-by-step explanation).

Sonography before and after carpal tunnel release: video article.

Carpal tunnel release for compression of the median nerve at the wrist is a common procedure, often resulting in good clinical outcomes. There are, however, many anatomical variations in and around the carpal tunnel and it is important to be aware of these during carpal tunnel release. After surgery, recurrent carpal tunnel syndrome is uncommon, but difficult to diagnose and treat. Ultrasonography is often necessary for the evaluation of the anatomical variations before carpal tunnel release and to evaluate the most common complications after carpal tunnel release.

Disc Excision using Transanal Circular Stapler for Deep Endometriosis of the Rectum in 10 Steps

Deep endometriosis infiltrating the rectum may be managed by full-thickness disc excision, with the goal of preserving rectal function and avoiding low anterior rectal resection syndrome (Supplemental Appendix 1). Transanal staplers may be successfully used to remove rectal wall discs and concomitantly to perform rectal suture. The goal of this video article is to identify 10 steps that may render the procedure standardized and reproducible. Step-by-step video demonstration of the procedure. A French tertiary referral center. The video presents disc excision of deep endometriosis infiltrating the rectum using a transanal circular stapler, following 10 steps: (1) nodule dissection and rectum releasing; (2) rectal shaving; (3) removal of fat tissue on the lateral rectal wall; (4) placement of a suture on the shaved area; (5) introduction of the closed transanal circular stapler; (6) stapler opening at the nodule's level; (7) knot performing; (8) stapler closing and firing; (9) stitches reinforcing the stapled line; and (10) performing a bubbles test. From 2009 to 2020, the author has performed this procedure in 205 patients: the mean disc diameter was 40 ± 8 mm; microscopic foci were found on the disc edges in 25.7%; and the rectal recurrence rate was 1.5%, whereas the leakage rate was 4.4%. The local institutional review board stated that approval was not required because the video describes a technique and does not report a clinical case. Disc excision using a transanal circular stapler following 10 steps is a standardized and reproducible procedure. The learning curve may be short because colorectal surgeons routinely employ the stapler to perform laparoscopic colorectal anastomosis.