Material and setup for a TaTME

1. Theatre set-up & equipment
Y. Van Nieuwenhove
UZGent - GIHK

3. Anesthetist
Abdominal
team
Transanal
team
Transanal tower
Abdominal tower
Airseal

4. Patient position
• Abdominal part
– Lloyd Davis position
– (Left arm in abduction)
– Trendelenburg – right tilt
• Perineal part
– Mobile leg supports
– Perineal elevation

5. Synchronous / sequential ?
• 2 teams (synchronous)
– Shorter and easier
– 2 towers
– 2 cameras
– 2 hemostatic generators
• 1 team (sequential)
– Less equipment required
– Longer and less control

6. Abdominal team
• Setup similar to left
colectomy
• No linear stapler required
• Surgeon/assistant right
• Tower left flank
• Normal insufflation

7. Perineal team
• Starts later (peritoneal deflection)
• Separated table
• Tower at level of head
• Surgeon and assistant between
legs
• Airseal insufflation

8. Perineal table
• Lonestar (or Galaxy) retractor
• Gelpoint Path
• Monopolar hook
• Airseal trocar
• Fenestrated grasper
• Surgipro 0 small (26mm) needle (2 pcs)
• “Peanut” cottons
• Hemorrhoidal stapler with long detachable spike

9. Gelpoint Path
• Dilatator
• Access channel
• Gelseal cap
• 3 trocarts (only 2
needed)

10. Airseal
• Valveless
• Stable pneumoperitoneum
– In small spaces
– with maximal suction
• Constant smoke evacuation
• !don’t get liquid in filter!

11. Hemorrhoidal stapler
• 33mm
• Long spike to facilitate
transanal connection
• Detachable spike
• Comes with “Longo” retractor