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  1. Article: Mesentery in Transanal TME.

    Knol, Joep / Chadi, Sami A

    Clinics in colon and rectal surgery

    2022  Volume 35, Issue 4, Page(s) 306–315

    Abstract: Oncological adequacy in rectal cancer surgery mandates not only a clear distal and circumferential resection margin but also resection of the entire ontogenetic mesorectal package. Incomplete removal of the mesentery is one of the commonest causes of ... ...

    Abstract Oncological adequacy in rectal cancer surgery mandates not only a clear distal and circumferential resection margin but also resection of the entire ontogenetic mesorectal package. Incomplete removal of the mesentery is one of the commonest causes of local recurrences. The completeness of the resection is not only determined by tumor and patient related factors but also by the patient-tailored treatment selected by the multidisciplinary team. This is performed in the context of the technical ability and experience of the surgeon to ensure an optimal total mesorectal excision (TME). In TME, popularized by Professor Heald in the early 1980s as a sharp dissection through the avascular embryologic plane, the midline pedicle of tumor and mesorectum is separated from the surrounding, mostly paired structures of the retroperitoneum. Although TME significantly improved the oncological and functional results of rectal cancer surgery, the difficulty of the procedure is still mainly dependent on and determined by the dissection of the most distal part of the rectum and mesorectum. To overcome some of the limitations of working in the narrowest part of the pelvis, robotic and transanal surgery have been shown to improve the access and quality of resection in minimally invasive techniques. Whatever technique is chosen to perform a TME, embryologically derived planes and anatomical points of reference should be identified to guide the surgery. Standardization of the chosen technique, widespread education, and training of surgeons, as well as caseloads per surgeon, are important factors to optimize outcomes. In this article, we discuss the introduction of transanal TME, with emphasis on the mesentery, relevant anatomy, standard procedural steps, and importance of a training pathway.
    Language English
    Publishing date 2022-08-10
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2048635-2
    ISSN 1531-0043
    ISSN 1531-0043
    DOI 10.1055/s-0042-1748887
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Total Mesorectal Excision Technique-Past, Present, and Future.

    Knol, Joep / Keller, Deborah S

    Clinics in colon and rectal surgery

    2020  Volume 33, Issue 3, Page(s) 134–143

    Abstract: While the treatment of rectal cancer is multimodal, above all, a proper oncological resection is critical. The surgical management of rectal cancer has substantially evolved over the past 100 years, and continues to progress as we seek the best treatment. ...

    Abstract While the treatment of rectal cancer is multimodal, above all, a proper oncological resection is critical. The surgical management of rectal cancer has substantially evolved over the past 100 years, and continues to progress as we seek the best treatment. Rectal cancer was historically an unsurvivable disease, with poor understanding of the embryological planes, lymphatic drainage, and lack of standardized technique. Major improvements in recurrence, survival, and quality of life have resulted from advances in preoperative staging, pathologic assessment, the development and timing of multimodal therapies, and surgical technique. The most significant contribution in advancing rectal cancer care may be the standardization and widespread implementation of total mesorectal excision (TME). The TME, popularized by Professor Heald in the early 1980s as a sharp, meticulous dissection of the tumor and mesorectum with all associated lymph nodes through the avascular embryologic plane, has shown universal reproducible reductions in local recurrence and improvement in disease-free and overall survival. Widespread education and training of surgeons worldwide in the TME have significantly impact outcomes for rectal cancer surgery, and the procedure has become the gold standard for curative resection of rectal cancer. In this article, we discuss the evolution of the standard abdominal approach to the TME, with emphasis on the history, relevant anatomy, standard procedure steps, oncologic outcomes, and technical evolution.
    Language English
    Publishing date 2020-04-28
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2048635-2
    ISSN 1531-0043
    ISSN 1531-0043
    DOI 10.1055/s-0039-3402776
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Cognitive skills training in digital era: A paradigm shift in surgical education using the TaTME model.

    Knol, Joep / Keller, Deborah S

    The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

    2018  Volume 17, Issue 1, Page(s) 28–32

    Abstract: Surgical competence is a complex, multifactorial process, requiring ample time and training. Optimal training is based on acquiring knowledge and psychomotor and cognitive skills. Practicing surgical skills is one of the most crucial tasks for both the ... ...

    Abstract Surgical competence is a complex, multifactorial process, requiring ample time and training. Optimal training is based on acquiring knowledge and psychomotor and cognitive skills. Practicing surgical skills is one of the most crucial tasks for both the novice surgeon learning new procedures and surgeons already in practice learning new techniques. Focus is placed on teaching traditional technical skills, but the importance of cognitive skills cannot be underestimated. Cognitive skills allow recognizing environmental cues to improve technical performance including situational awareness, mental readiness, risk assessment, anticipating problems, decision-making, adaptation, and flexibility, and may also accelerate the trainee's understanding of a procedure, formalize the steps being practiced, and reduce the overall training time to become technically proficient. The introduction and implementation of the transanal total mesorectal excision (TaTME) into practice may be the best demonstration of this new model of teaching and training, including pre-training, course attendance, and post-course guidance on technical and cognitive skills. To date, the TaTME framework has been the ideal model for structured training to ensure safe implementation. Further development of metrics to grade successful learning and assessment of long term outcomes with the new pathway will confirm the success of this training model.
    MeSH term(s) Clinical Competence ; Dissection ; Humans ; Mesentery/surgery ; Psychomotor Performance ; Rectal Neoplasms/surgery ; Rectum/surgery ; Teaching ; Transanal Endoscopic Microsurgery/methods ; Transanal Endoscopic Microsurgery/standards
    Language English
    Publishing date 2018-04-30
    Publishing country Scotland
    Document type Journal Article ; Review
    ZDB-ID 2102927-1
    ISSN 1479-666X
    ISSN 1479-666X
    DOI 10.1016/j.surge.2018.03.008
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  4. Article: Total Mesorectal Excision Technique—Past, Present, and Future

    Knol, Joep / Keller, Deborah S.

    Clinics in Colon and Rectal Surgery

    (Transanal Total Mesorectal Excision)

    2020  Volume 33, Issue 03, Page(s) 134–143

    Abstract: While the treatment of rectal cancer is multimodal, above all, a proper oncological resection is critical. The surgical management of rectal cancer has substantially evolved over the past 100 years, and continues to progress as we seek the best treatment. ...

    Series title Transanal Total Mesorectal Excision
    Abstract While the treatment of rectal cancer is multimodal, above all, a proper oncological resection is critical. The surgical management of rectal cancer has substantially evolved over the past 100 years, and continues to progress as we seek the best treatment. Rectal cancer was historically an unsurvivable disease, with poor understanding of the embryological planes, lymphatic drainage, and lack of standardized technique. Major improvements in recurrence, survival, and quality of life have resulted from advances in preoperative staging, pathologic assessment, the development and timing of multimodal therapies, and surgical technique. The most significant contribution in advancing rectal cancer care may be the standardization and widespread implementation of total mesorectal excision (TME). The TME, popularized by Professor Heald in the early 1980s as a sharp, meticulous dissection of the tumor and mesorectum with all associated lymph nodes through the avascular embryologic plane, has shown universal reproducible reductions in local recurrence and improvement in disease-free and overall survival. Widespread education and training of surgeons worldwide in the TME have significantly impact outcomes for rectal cancer surgery, and the procedure has become the gold standard for curative resection of rectal cancer. In this article, we discuss the evolution of the standard abdominal approach to the TME, with emphasis on the history, relevant anatomy, standard procedure steps, oncologic outcomes, and technical evolution.
    Keywords rectal cancer ; total mesorectal excision (TME) ; transanal total mesorectal excision (TaTME) ; holy plane ; mesorectal fascia
    Language English
    Publishing date 2020-04-28
    Publisher Thieme Medical Publishers
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 2048635-2
    ISSN 1530-9681 ; 1531-0043
    ISSN (online) 1530-9681
    ISSN 1531-0043
    DOI 10.1055/s-0039-3402776
    Database Thieme publisher's database

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  5. Article ; Online: A stepwise approach to laparoscopic splenic flexure mobilization - A Video Vignette.

    Oosenbrug, Marcus / Guidolin, Keegan / Knol, Joep / Melani, Armando G F / Quereshy, Fayez / Chadi, Sami

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2022  Volume 25, Issue 3, Page(s) 509–510

    MeSH term(s) Humans ; Colon, Transverse/surgery ; Laparoscopy ; Anastomosis, Surgical ; Colectomy
    Language English
    Publishing date 2022-10-08
    Publishing country England
    Document type Video-Audio Media ; Letter
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.16346
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    Zs.A 5799: Show issues Location:
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  6. Article ; Online: Transanal total mesorectal excision: technical aspects of approaching the mesorectal plane from below.

    Knol, Joep / Chadi, Sami A

    Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy

    2016  Volume 25, Issue 5, Page(s) 257–270

    Abstract: Standardization of transanal total mesorectal excision requires the delineation of the principal procedural components before implementation in practice. This technique is a bottom-up approach to a proctectomy with the goal of a complete mesorectal ... ...

    Abstract Standardization of transanal total mesorectal excision requires the delineation of the principal procedural components before implementation in practice. This technique is a bottom-up approach to a proctectomy with the goal of a complete mesorectal excision for optimal outcomes of oncologic treatment. A detailed stepwise description of the approach with technical pearls is provided to optimize one's understanding of this technique and contribute to reducing the inherent risk of beginning a new procedure. Surgeons should be trained according to standardized pathways including online preparation, observational or hands-on courses as well as the potential for proctorship of early cases experiences. Furthermore, technological pearls with access to the "video-in-photo" (VIP) function, allow surgeons to link some of the images in this article to operative demonstrations of certain aspects of this technique.
    MeSH term(s) Humans ; Laparoscopy/methods ; Operating Rooms/organization & administration ; Patient Care Team ; Rectal Neoplasms/surgery ; Transanal Endoscopic Surgery/methods
    Keywords covid19
    Language English
    Publishing date 2016-10
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 1317160-4
    ISSN 1365-2931 ; 1364-5706
    ISSN (online) 1365-2931
    ISSN 1364-5706
    DOI 10.1080/13645706.2016.1206572
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    Zs.A 3467: Show issues Location:
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  7. Article ; Online: Laparoscopic mobilization of the splenic flexure: the use of color-grading as a unique teaching tool.

    Knol, Joep J A / Wexner, Steven D / Vangertruyden, Guido

    Surgical endoscopy

    2015  Volume 29, Issue 3, Page(s) 734–735

    Abstract: This video shows submesocolic medial-to-lateral laparoscopic mobilization of the splenic flexure in which embryologically-derived planes are highlighted using colorized parts in a black and white background. The concept of traction and counter-traction ... ...

    Abstract This video shows submesocolic medial-to-lateral laparoscopic mobilization of the splenic flexure in which embryologically-derived planes are highlighted using colorized parts in a black and white background. The concept of traction and counter-traction is used to create a tissue "bridge" to work beneath, making efficient use of both of the surgeon's hands. To our knowledge, the color-grading technique has not been previously used to edit a video of a laparoscopic procedure, thus creating a new method of teaching.
    MeSH term(s) Colon, Transverse/surgery ; Education, Medical/methods ; General Surgery/education ; Humans ; Laparoscopy/education ; Teaching Materials
    Language English
    Publishing date 2015-03
    Publishing country Germany
    Document type Journal Article ; Video-Audio Media
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-014-3727-z
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  8. Article ; Online: A survey of European-African surgeons' management of common bile duct stones.

    Vannijvel, Marie / Lesurtel, Mickael / Bouckaert, Wim / Houben, Bert / Knol, Joep / Vangertruyden, Guido / Sergeant, Gregory

    HPB : the official journal of the International Hepato Pancreato Biliary Association

    2016  Volume 18, Issue 12, Page(s) 959–964

    Abstract: Background: Common bile duct (CBD) stones can be managed by either endoscopic retrograde cholangiopancreatography (ERCP) or laparoscopic common bile duct exploration (LCBDE). The aim of this survey was to document the management of CBD stones by ... ...

    Abstract Background: Common bile duct (CBD) stones can be managed by either endoscopic retrograde cholangiopancreatography (ERCP) or laparoscopic common bile duct exploration (LCBDE). The aim of this survey was to document the management of CBD stones by European-African HPB Association (E-AHPBA) members.
    Methods: All 331 members of the E-AHPBA were invited by personal email to participate to an online survey.
    Results: Ninety-three (28%) surgeons replied within 2 months. Responding surgeons were attending surgeons (84%), working as HPB surgeons (75%) in academic hospitals (73%). In patients with clinically suspected CBD stones, MRCP was the preferred diagnostic test for 61% of respondents. LCBDE was the preferred therapeutic strategy for 11 (12%) respondents only. Previous gastric surgery was an absolute contraindication to ERCP for 47% of respondents. Absence of CBD dilation was considered an absolute contraindication for LCBDE in 24% of respondents. Yearly caseload exceeded 10 patients for only 30% of 56 centers performing LCBDE. The transcystic approach was preferred by 39% of surgeons performing LCBDE. There was considerable variation amongst respondents with regard to type and duration of drainage, bile duct closure technique and follow-up after LCBDE.
    Conclusion: Indications for single-stage LCBDE are not standardized and do not appear well established across E-AHPBA members.
    MeSH term(s) Adult ; Africa ; Cholangiopancreatography, Endoscopic Retrograde/adverse effects ; Cholangiopancreatography, Endoscopic Retrograde/trends ; Cholecystectomy, Laparoscopic/adverse effects ; Cholecystectomy, Laparoscopic/trends ; Choledocholithiasis/diagnostic imaging ; Choledocholithiasis/surgery ; Europe ; Gallstones/diagnostic imaging ; Gallstones/surgery ; Health Care Surveys ; Healthcare Disparities/trends ; Humans ; Middle Aged ; Practice Patterns, Physicians'/trends ; Surgeons/trends ; Time Factors ; Treatment Outcome ; Workload
    Language English
    Publishing date 2016-12
    Publishing country England
    Document type Journal Article
    ZDB-ID 2131251-5
    ISSN 1477-2574 ; 1365-182X
    ISSN (online) 1477-2574
    ISSN 1365-182X
    DOI 10.1016/j.hpb.2016.10.007
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    Zs.A 6326: Show issues Location:
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  9. Article ; Online: New Paradigm of Live Surgical Education: Synchronized Deferred Live Surgery.

    Knol, Joep / Bonjer, Jaap / Houben, Bert / Wexner, Steven D / Hompes, Roel / Atallah, Sam / Heald, Richard J / Sietses, Colin / Chadi, Sami A

    Journal of the American College of Surgeons

    2018  Volume 227, Issue 4, Page(s) 467–473

    MeSH term(s) Education, Medical/methods ; Humans ; Organizational Policy ; Patient Care Team ; Patient Safety ; Patient Selection ; Surgical Procedures, Operative/education ; Teaching
    Language English
    Publishing date 2018-08-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1181115-8
    ISSN 1879-1190 ; 1072-7515
    ISSN (online) 1879-1190
    ISSN 1072-7515
    DOI 10.1016/j.jamcollsurg.2018.07.660
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  10. Article ; Online: Quality of life after rectal cancer surgery: differences between laparoscopic and transanal total mesorectal excision.

    Veltcamp Helbach, Marloes / Koedam, Thomas W A / Knol, Joep J / Velthuis, Simone / Bonjer, H Jaap / Tuynman, Jurriaan B / Sietses, Colin

    Surgical endoscopy

    2018  Volume 33, Issue 1, Page(s) 79–87

    Abstract: Background: Transanal total mesorectal excision (TaTME) is a safe alternative to laparoscopic TME for mid and low rectal cancer. TaTME allows improved visualization of the surgical planes and margins, and may potentially improve oncological outcomes. ... ...

    Abstract Background: Transanal total mesorectal excision (TaTME) is a safe alternative to laparoscopic TME for mid and low rectal cancer. TaTME allows improved visualization of the surgical planes and margins, and may potentially improve oncological outcomes. However, functional results after total mesorectal excision (TME) are variable and there are currently only a few published studies that include functional data related to the outcomes of TaTME.
    Methods: Fifty-four consecutive patients were included in this study: one group included 27 patients who underwent laparoscopic low anterior and the other included 27 patients who underwent TaTME. All patients were asked to complete five questionnaires related to quality of life (QOL) and function [EQ-5D-3L, EORTC-QLQ C30, EORTC-QLQ C29, Low Anterior Resection Syndrome score (LARS), and International Prostate Symptom Score IPSS]. All TaTME patients were operated on at The Gelderse Vallei Hospital by a single surgeon and had a follow-up of at least 6.6 months.
    Results: The EORTC-QLQ C30 and EQ-5D-3L questionnaires showed comparable outcomes in terms of QOL between the two groups. Almost all items evaluated by the EORTC-QLQ C29, including sexual outcomes, were similar between the two groups. One item concerning fecal incontinence, however, was scored worse for TaTME. There were no significant differences between the groups in terms of LARS symptoms or urinary function.
    Conclusions: Patients undergoing laparoscopic or transanal TME showed comparable functional and QOL outcomes. Although the TaTME technique is still evolving, this study indicates that this technique is a safe alternative to laparoscopic surgery in terms of functional outcomes for mid and low rectal cancers.
    MeSH term(s) Aged ; Female ; Humans ; Laparoscopy/methods ; Male ; Margins of Excision ; Middle Aged ; Postoperative Complications/etiology ; Quality of Life ; Rectal Neoplasms/psychology ; Rectal Neoplasms/surgery ; Rectum/surgery ; Transanal Endoscopic Surgery/methods
    Keywords covid19
    Language English
    Publishing date 2018-07-02
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 639039-0
    ISSN 1432-2218 ; 0930-2794
    ISSN (online) 1432-2218
    ISSN 0930-2794
    DOI 10.1007/s00464-018-6276-z
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