If you are interested, you can see a complete TME procedure webcast from the Brigham and Women's Hospital in Boston, narrated by Michael Zinner, the Chairman of the department of surgery, the operation being performed by Dr Ronald Bleday. In the webcast, it is readily apparent that an entire surgical team is required for what appears to be a relatively small operating field.
Seeing the mesorectal fascia as the excised rectal specimen is removed, I now have a far better visual appreciation for what the pathologist will want to examine during the procedure itself. The complexity of the anterior and posterior dissection, the care with which the nerves and other abdominal structures are preserved and protected, and the vascular complexity of the anatomy all amaze me.
Hearing the narrator address the email questions from surgeons watching the webcast is especially helpful since it addresses many of the questions I have. One was the length of time for urinary catherization for male patients. Three to 4 days postoperatively is standard, partially because of the thoracic epidural used for postoperative pain control - the epidural takes about 3-4 days to leave the system of the patient.
It is also very clear to me that some decisions cannot be made until the time of surgery itself; things like implementing a J-pouch or not, the kind of anastomosis, whether and how long to drain or irrigate, etc. - some things which are determined by space available in the pelvis, the health of the tissues, and the surgeon's personal preferences.
The temporary ileostomy possibility, for instance, depends upon a visual examination of the resected tissues and an almost intuitive sense on the part of the surgeon as to whether there is a risk of leakage in the anastomosis.
In watching this video, I have been pleased to realize the professionalism and currency of the treatment protocol being followed by my medical team at the Grand River Regional Cancer Centre.