Patricia Sylla1, Joep J Knol2, Anthony P D'Andrea1, Rodrigo O Perez3, Sam B Atallah4, Marta Penna5, Roel Hompes6, Albert Wolthuis7, Philippe Rouanet8, Abe Fingerhut9,10. 1. Department of Surgery, Division of Colon and Rectal Surgery, Icahn School of Medicine at Mount Sinai, New York, NY. 2. Department of Abdominal Surgery, Jessa Hospital, Hasselt, Belgium. 3. Colorectal Surgery Division, Angelita and Joaquim Gama Institute, São Paulo, Brazil. 4. Department of Colorectal Surgery, Advent Health Medical Group, Orlando, FL. 5. Department of Colorectal Surgery, Churchill Hospital, University Hospitals of Oxford, Oxford, UK. 6. Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands. 7. Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium. 8. Surgical Oncology Department, Institut du Cancer de Montpellier, Montpellier, France. 9. Department of Surgery and Surgical Research, University of Graz, Graz, Austria. 10. Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Abstract
OBJECTIVE: To identify risk factors for urethral and urologic injuries during transanal total mesorectal excision (taTME) and evaluate outcomes. BACKGROUND: Urethral injury is a rare complication of abdominoperineal resection (APR) that has not been reported during abdominal proctectomy. The Low Rectal Cancer Development Program international taTME registry recently reported a 0.8% incidence, but actual incidence and mechanisms of injury remain largely unknown. METHODS: A retrospective analysis of taTME cases complicated by urologic injury was conducted. Patient demographics, tumor characteristics, intraoperative details, and outcomes were analyzed, along with surgeons' experience and training in taTME. Surgeons' opinion of contributing factors and best approaches to avoid injuries were evaluated. RESULTS: Thirty-four urethral, 2 ureteral, and 3 bladder injuries were reported during taTME operations performed over 7 years by 32 surgical teams. Twenty injuries occurred during the teams' first 8 taTME cases ("early experience"), whereas the remainder occurred between the 12th to 101st case. Injuries resulted in a 22% conversion rate and 8% rate of unplanned APR or Hartmann procedure. At median follow-up of 27.6 months (range, 3-85), the urethral repair complication rate was 26% with a 9% rate of failed urethral repair requiring permanent urinary diversion. In patients with successful repair, 18% reported persistent urinary dysfunction. CONCLUSIONS: Urologic injuries result in substantial morbidity. Our survey indicated that those occurring in surgeons' early experience might best be reduced by implementation of structured taTME training and proctoring, whereas those occurring later relate to case complexity and may be avoided by more stringent case selection.
OBJECTIVE: To identify risk factors for urethral and urologic injuries during transanal total mesorectal excision (taTME) and evaluate outcomes. BACKGROUND:Urethral injury is a rare complication of abdominoperineal resection (APR) that has not been reported during abdominal proctectomy. The Low Rectal Cancer Development Program international taTME registry recently reported a 0.8% incidence, but actual incidence and mechanisms of injury remain largely unknown. METHODS: A retrospective analysis of taTME cases complicated by urologic injury was conducted. Patient demographics, tumor characteristics, intraoperative details, and outcomes were analyzed, along with surgeons' experience and training in taTME. Surgeons' opinion of contributing factors and best approaches to avoid injuries were evaluated. RESULTS: Thirty-four urethral, 2 ureteral, and 3 bladder injuries were reported during taTME operations performed over 7 years by 32 surgical teams. Twenty injuries occurred during the teams' first 8 taTME cases ("early experience"), whereas the remainder occurred between the 12th to 101st case. Injuries resulted in a 22% conversion rate and 8% rate of unplanned APR or Hartmann procedure. At median follow-up of 27.6 months (range, 3-85), the urethral repair complication rate was 26% with a 9% rate of failed urethral repair requiring permanent urinary diversion. In patients with successful repair, 18% reported persistent urinary dysfunction. CONCLUSIONS: Urologic injuries result in substantial morbidity. Our survey indicated that those occurring in surgeons' early experience might best be reduced by implementation of structured taTME training and proctoring, whereas those occurring later relate to case complexity and may be avoided by more stringent case selection.
Authors: Antonio Caycedo-Marulanda; Carl J Brown; Sami A Chadi; Shady Ashamalla; Lawrence Lee; Peter Stotland; Usmaan Hameed; George Melich; Grace Ma; Francois Letarte; Ahmer Karimuddin; Fayez Quereshy; Terry Phang; Manoj Raval; Elena Vikis; A Sender Liberman; Alexandre Bouchard; Phillipe Bouchard; Sebastien Drolet Journal: Surg Endosc Date: 2020-06-05 Impact factor: 4.584
Authors: J A G van der Heijden; T Koëter; L J H Smits; C Sietses; J B Tuynman; A J G Maaskant-Braat; B R Klarenbeek; J H W de Wilt Journal: Br J Surg Date: 2020-03-10 Impact factor: 6.939