Pelvic TME dissection in a woman with LigaSure Advance: Tips'n tricks

This video presents a stepwise approach to a TME dissection in a female patient. It shows the advantages of using the new Ligasure advance for landmark identification and preservation in restrained areas; here, the pelvic area.

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Pelvic   TME   dissection   in   a   woman   with   LigaSure   Advance:   Tips'n   tricks

Authors
J Leroy, J Marescaux
Abstract
This video presents a stepwise approach to a TME dissection in a female patient. It shows the advantages of using the new Ligasure advance for landmark identification and preservation in restrained areas; here, the pelvic area.
Classification
tips and tricks
Keywords
pelvic TME, dissection, woman, LigaSure Advance™, tips\'n tricks, cancer
Media type
Duration
03'00''
Publication
2008-09
Popular
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Audio
en
Subtitles
en
E-publication
WeBSurg.com, Sept 2008;8(09).
URL: http://www.websurg.com/doi-vd01en2352.htm

Pelvic   TME   dissection   in   a   woman   with   LigaSure   Advance:   Tips'n   tricks

1. Case presentation 00'19''
This video shows the different steps of the posterior dissection during a total mesorectal excision in a young female patient, presenting with a case of lower rectum cancer. Here we can see the posterior traction performed on the mesorectum with the help of a 5mm Ligasure device using monopolar coagulation. The lateral dissection is continued first in front of the round ligaments and by performing an incision of the peritoneum. The dissection is continued in a conical fashion and in a way that preserves the rectum’s fascia propria: this is done in order to perform a good TME. Dissection is carried on with the continued use of monopolar coagulation and with the help of traction and counter-traction using peanuts as you can see here. At this level, we can observe the progression of the posterior dissection that allows to identify the pelvic floor; the lateral dissection is continued to the left of the patient. This lateral dissection will allow to identify the nerve plexus and to identify the medial rectal artery that we will dissect with the help of the 5mm Ligasure device in an atraumatic way. Once dissected, we perform the vessel’s coagulation in order to allow the complete freeing of the operative specimen. Once the lateral dissection has been achieved, we begin the anterior dissection. This one aims at incising the peritoneum in front of the rectum’s anterior part and at the level of the Douglas’ pouch. Using traction and counter-traction, this dissection is continued at the level of the rectovaginal wall in order to identify its anatomical landmark. This dissection is performed entirely with monopolar coagulation.