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Total mesorectal excision (TME) is a precise dissection of the rectum and all pararectal lymph nodes within an oncologic package: the mesorectal envelope. This article is a brief description of the technical aspects of the dissection, illustrated by cadaver dissection. Here the TME dissection is organized into 6 steps to facilitate learning: (1) left retroperitoneum; (2) superior rectal and inferior mesenteric vessels; (3) upper mesorectum; (4/5) right and left mid-mesorectum; and (6) distal mesorectum and anorectal junction. The relationship of the autonomic nerves, blood vessels and adjacent organ structures are described at each step. The 6 steps are recommended for learning and performing TME dissection in cadavers and patients.
L'excision mesorectale totale (EMT) est une dissection du rectum et de tous les ganglions lymphatiques pararectaux dans un ensemble oncologique : l'enveloppe mesorectale. Cet article decrit brievement les aspects techniques de la dissection, illustres par une dissection de cadavre. La dissection EMT est subdivisee en 6 etapes de facon a faciliter l'apprentissage : (1) retroperitoine gauche; (2) vaisseaux rectaux superieurs et mesenteriques inferieurs; (3) mesorectum superieur; (4/5) mesorectum intermediaire droit et gauche; (6) mesorectum distal et jonction anorectale. On decrit a chaque etape le lien entre les nerfs autonomes, les vaisseaux sanguins et les structures des organes adjacents. On recommande la demarche en 6 etapes pour apprendre la dissection EMT et la pratiquer sur des cadavres et des patients.
Total mesorectal excision (TME) is becoming accepted universally as the preferred technique for surgical excision of rectal cancer. TME results in the lowest rates of local recurrence, especially when combined with preoperative radiation treatment.1-4 A second benefit of TME is increased sparing of the anal sphincter, with a concomitant decrease in permanent stomas from abdominoperineal resection (APR).5 The third benefit is that TME is a nerve-sparing dissection, less likely to lead to bladder and sexual dysfunction.6,7 This article is a brief discussion of the technical aspects of TME, illustrated by photographs of cadaver dissection and a surgical TME specimen.
TME is "specimen-oriented" surgery: completeness of the mesorectal excision predicts local recurrence and survival.4,8,9 A simple analogy may be excision of a sebaceous cyst: recurrence is more likely if the cyst wall is incompletely excised or the cyst is perforated. The key technical points of TME...