Medicine

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    Double single-port pan-proctocolectomy with transanal total mesorectal excision [TaTME] and ileal pouch-anal anastomosis [IPAA]: improvisation under limited resources
    (College of Surgeons of Sri Lanka, 2020) Chandrasinghe, P.; Kumarage, S.
    ABSTRACT: Novel surgical techniques fail to reach all parts of the world equally due to financial constraints. Non-availability of high-cost equipment in the developing world hinders progress. Transanal total mesorectal incision [TaTME] is a novel technique becoming popular world over due to many perceived benefits. Some of the equipment requirements prevent surgeons in resource-limited environments from taking up this technique. We describe the performance of a double single port panproctocolectomy with TaTME and ileal pouch-anal anastomosis for a patient with colitis-associated rectal cancer under improvised conditions at a tertiary care centre in Sri Lanka. Standard practice requires two laparoscopic stacks and an integrated air insufflator both of which are not available in the local setting. A flexible endoscope was used to replace the need for a second laparoscopic stack and a simple drainage bag connection to the standard insufflator to provide a stable pneumo-peritoneum. The patient had a rapid uneventful recovery. KEYWORDS: TaTME, Double single port, Innovation, Pouch surgery
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