"Near-TME" : proposed standardisation of the technique for proctectomy in male patients with ulcerative colitis
Garcia-Granero, Alvaro (Universitat de les Illes Balears)
Pellino, Gianluca (Hospital Universitari Vall d'Hebron)
Fletcher-Sanfeliu, Delfina (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Millan, Monica (Hospital Universitari i Politècnic La Fe (València))
Primo-Romaguera, Vicent (Hospital Universitari i Politècnic La Fe (València))
Garcia Gausí, Maria (Universitat de València)
Fernandez, M. (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
González Argenté, F. Xavier (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Spinelli, Antonino (Humanitas Research Hospital (Itàlia))
Valverde-Navarro, Alfonso (Universitat de València)
García-Granero, Eduardo (Hospital Universitari i Politècnic La Fe (València))
Universitat Autònoma de Barcelona

Date:	2022
Abstract:	The aim of the present study was to describe in detail an approach to proctectomy in ulcerative colitis (UC), which can be standardized; near-total mesorectal excision (near-TME), to prevent injuries to autonomic pelvic nerves and subsequent sexual dysfunction. We demonstrate the technique ex vivo on a cadaver from a male patient in lithotomy position and on a sagittal section of a male pelvis. We also demonstrate the technique in vivo in two male patients diagnosed with UC, with no history of sexual dysfunction or bowel neoplasia. The study was performed at the Human Embryology and Anatomy Department. University of Valencia, Spain. The posterolateral dissection during a near-TME is similar to that of an oncologic TME, whereas the anterolateral is similar to that of a close rectal dissection. The near-TME technique preserves the superior hypogastric plexus, the hypogastric nerves, the nervi erigentes, the inferior hypogastric plexus, the pelvic plexus and the cavernous nerves. The near-TME technique is the standardisation of the technique for proctectomy in male patients with ulcerative colitis. Near-TME requires experience in pelvic surgery and an exhaustive knowledge of the embryological development and of the surgical anatomy of the pelvis. The online version contains supplementary material available at 10. 1007/s10151-022-02579-z.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Ulcerative colitis ; Proctectomy ; Close rectal dissection ; Intra-mesorectal ; Inflammatory bowel diseases ; Surgical anatomy
Published in:	Techniques in Coloproctology, Vol. 26 (february 2022) , p. 217-226, ISSN 1128-045X

DOI: 10.1007/s10151-022-02579-z
PMID: 35103902

10 p, 2.5 MB

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