DETAILS OF TOTAL MESORECTAL EXCISION IN COMBINED APPROACH: LAPAROSCOPIC + TEO

Introduction It is estimated that in 2023, Brasil registered more than 45,000 cases of colorectal cancer. The standardization of the total mesorectal excision technique by Heald in 1982, which involves precise dissection of the mesorectal fascia and removal of an intact specimen, led to a decline in local recurrence rates from 30% to 5%. Additionally, the use of laparoscopy combined with the TEO platform in distal rectal cancer surgeries, besides ensuring a good postoperative recovery, can facilitate the dissection with total mesorectal excision and careful rectal sectioning, especially in cases requiring manual coloanal anastomosis.

Objectives To demonstrate the combined technique of laparoscopy and the TEO platform as an option that may result in more careful surgery in patients with distal rectal tumors requiring total mesorectal excision.

Methods A 78-year-old patient presented with a history of hematochezia for 5 years. Colonoscopy indicated a vegetative and ulcerated lesion on the posterior wall of the rectum about 2 cm from the anal margin, with histopathological diagnosis of adenocarcinoma. Staging MRI showed a T2N0 tumor, and thoracic and abdominal CT scans showed no evidence of distant disease. A decision was made to proceed with upfront surgery, performed laparoscopically combined with the TEO platform for appropriate mesorectal dissection at the most distal portion, without violation, and distal rectal sectioning.

Results The use of videolaparoscopy for the abdominal portion allowed for sharp dissection of the mesorectal plane, obtaining an intact mesorectum, preservation of nerves and autonomic plexuses, and appropriate distal mesorectal clearing. In addition, the use of the TEO platform ensured careful sectioning under direct vision of the anal canal, preserving the tissues for the manual coloanal anastomosis.

Conclusion The combination of less invasive surgical techniques, such as videolaparoscopy and the TEO platform, can contribute to the careful and intact dissection of the mesorectum, as well as ensuring better postoperative recovery for the patient.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025