Dr. Joep Knol

Right Colectomy Best Practices To Avoid Anastomotic Leaks Complications

PROGRAM     1. Right colon resection - Dr. Joep Knol Dr. Joep Knol gives comments and advice about the procedure using 4 videos that cover different stages of right colon resection: D2 medial to lateral approach, lateral mobilization, resection, and reanastomosis. In addition to Dr. Knol’s comments, the videos are subtitled, providing information on the actions being performed during the operation.      2. Laparoscopic CME/CVL for right colon cancer - Dr. Yoon Suk Lee Experience in operations makes surgeons better, forcing them to overcome different challenges and finding the best way to perform the surgery. Laparoscopic CME with CVL is no different in this regard. In this video, Dr. Yoon Suk Lee gives his recommendations to achieve successful outcomes. 3 key points for a good surgery are covered. One, an effective technique for traction and counter traction, used by the surgeon and the assistant. Two, surgical energy systems to prevent leakage. And three, the placement of the trocars and the surgeons during the operation. To illustrate his recommendations, Dr. Lee comments on a laparoscopic operation. Finally, Dr. Less discusses the use of ICG for ICA to check the state of some organs. procedure for checking states of some organs, and gives 3 recommendations for a successful operation…     3. Interoperative anastomotic leak diagnosis: what to do. - Dr. Willem Bemelman Anastomotic leaks are severe complications in colorectal surgery, increasing the need to improve performance to prevent its consequences. In this video, Dr Willem Bemelman describes the 3 main factors to achieve the perfect anastomosis, and discusses the last one: technical integrity. However, there is no perfect technique. Various test techniques are explained using diagrams and studies on specific techniques (e.g. air leak testing). Dr. Bemelman also gives examples from his own cases. Nonetheless, tests can give us insufficient information. Dr. Bemelman explains some techniques to deal with this problem and discusses the overview technique. Finally, he summarizes the video giving some important points.

With Johnson & Johnson MedTech

Winter Event “From Diagnosis to Treatment in Rectal Cancer in 2015: A Real Patient”

In the introduction, Richard Heald, a world-renowned specialist in rectal cancer surgery, highlighted, among other things, the importance of the transanal technique, the progress that it represents in low rectal cancer, and its benefits in certain cases due to specific pelvic anatomy. Steven Wexner, the Head of the Digestive Disease Center and Colorectal surgery department at the Cleveland Clinic, chaired the following presentations and debates in which a group of expert gastroenterologists and radiologists discussed the guidelines to follow for diagnosis and tumor staging, covering the following topics: The importance of colonoscopy, the distance from the tumor to the anal verge, rigid rectoscopy and controversies in endoscopic tattooing. Staging according to the MRI and USE and the comparison between them Correct assessment for neoadjuvant treatment As well as the functional explanations required before and after rectal cancer surgery. Later Antoni Castells, Head of the Clinic Institute of Digestive and Metabolic Disease (ICMDM) at the Hospital Clinic in Barcelona, examined, together with the oncologists Cristina Nadal  (Hospital Clinic) and Robert Glynne-Jones (Mount Vernon Cancer Center) the various chemotherapy and preoperative radiotherapy options in rectal cancer, as well as which treatment should be selected and why, and the current trends based on the latest studies at the European and global level. Then a live surgery was performed: a Cecil approach to rectal cancer. Joep Knol (Belgium) and Patricia Sylla (United States) provided a step-by-step description of the procedure. While the surgery was being performed by Antonio Lacy and his team, the experts commented on several matters, such as technical considerations, main steps and  some controversies regarding the operation. Meanwhile, they received queries from online viewers which were answered from the main set and from the operating theatre. After removing the surgical specimen, the pathologists Maria Cuatrecasas (Hospital Clinic), Mariana Berho (Cleveland Clinic) and Philip Quirke (United Kingdom) proceeded to perform the initial analysis of the specimen in the operating room, focusing on the characteristics and quality of the mesorectum. After surgery other topics of interest were discussed, such as Routine Genetic Counseling for Rectal Cancer Patients by Francesc Balaguer (Hospital Clinic), postoperative treatment based on pre-op staging vs pathological examination by Jaume Capdevila (Vall d’ Hebron) and finally the pathology audit regarding the standardisation of pathological evaluation, the surgical margin and molecular lymph node assessment. Finally Steven Wexner made some final statements and spoke about the importance of training for TaTME and its key elements. Richard Heald and Antonio Lacy then made the closing remarks, bringing the event to its end.

Rectal Cancer, Transanal TME – Cecil Approach

Performed by Antonio M. Lacy, Salvadora Delgado & María F. Hevia. Described by Joep Knol and Patricia Sylla in the Operating Room. Co-discussants: Richard J. Heald, Steven D. Wexner & H. Jaap Bonjer. Live connection during the surgery with Philip Quirke, Mariana Berho and Míriam Cuatrecasas for the pathology examination of the specimen.

With Medtronic

TME by Transanal approach (TaTME) performed by Dr. Lacy

A live surgery with special interest for surgeons starting their experience with the TaTME. The procedure focuses on the key points for transanal dissection.

With Olympus

Transanal TME performed by two teams (Cecil Approach)

A transanal total mesorectal excision (TaTME) has been performed as a novel approach, two teams working simultaneously and using the latest technology.

With Olympus

The AirSeal® iFS System has been tested for TAMIS procedure

Clinical Case The Training Center of AIS Channel is a new educational system for surgeons in formation, composed by a variety of courses dedicated to diverse pathologies such as esophagogastric, bariatrics and minimally invasive techniques for colon diseases. The taTME course is the first of this modality, it was created with the purpose of training colorectal surgeons in the transanal approach for rectal cancer and proctectomy for ulcerative colitis. The last one was held this September providing theoretical knowledge and “hands on practice” in cadavers, during the live surgery demonstration Salvadora Delgado and Marta Jimenez performed transanal endoscopic microsurgery for a case of T1N0 rectal cancer. Some variations were used, the most useful was the AIR Seal iFS® from SurgiQuest, an intelligent insufflation system that provides stable pneumorectum and continuous smoke evacuation. Salvadora Delgado said “it's amazing how the rectal lumen stays stable with almost no smoke in the surgical field”, similar to the opinion of the surgeons that prove it in the cadaver dissection. This innovative device, based on Dr. Joep Knol's idea, may represent a solution for a common drawback during the transanal resection. In the video you can appreciate the difference between using the AIR Seal iFS® or maybe not, watch it and make your own opinion.