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Kawada et al . Mini-invasive Surg 2020;4:7 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2019.44

Technical Note Open Access

Utility of a lighted stent to avoid male urethral injury
in transanal rectal surgery

Kenji Kawada, Tomoaki Okada, Yoshiharu Sakai
Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto 6068507, Japan.

Correspondence to: Dr. Kenji Kawada, Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin
Kawahara-cho, Sakyo-ku, Kyoto 6068507, Japan. E-mail: kkawada@kuhp.kyoto-u.ac.jp

How to cite this article: Kawada K, Okada T, Sakai Y. Utility of a lighted stent to avoid male urethral injury in transanal rectal
surgery. Mini-invasive Surg 2020;4:7. http://dx.doi.org/10.20517/2574-1225.2019.44

Received: 18 Oct 2019 First Decision: 30 Dec 2019 Revised: 31 Dec 2019 Accepted: 15 Jan 2020 Published: 12 Feb 2020
Science Editor: Giulio Belli Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract
Total mesorectal excision (TME) is accepted as the standard technique in rectal surgery. In recent years, significant
attention has been focused on transanal TME (taTME) as a promising approach for rectal cancer. However, this approach
can involve an inherent risk of male urethral injury, because there is no clear anatomical border between the rectal
muscularis propria and rectourethral muscle. We used a lighted urethral stent to identify the urethra during taTME for 6
patients with distal rectal cancer. In five of six cases, an infrared-detecting camera could detect a red fluorescent signal
from the lighted urethral stent during the anterior dissection of the rectum, which helped us to determine the correct
dissection line. A lighted urethral stent is a useful tool that helps visualize the urethra during taTME and improves taTME
applicability in clinical practice.

Keywords: Transanal total mesorectal excision, lighted urethral stent, urethral injury

INTRODUCTION
Total mesorectal excision (TME), introduced by Heald, is accepted as the standard technique in rectal
[1]
surgery . As compared to open surgery, laparoscopic surgery can provide better visibility in a narrow
pelvic space, which enables surgeons to conduct precise TME surgery. Laparoscopic rectal surgery has
been accepted based on accumulating evidence; however, it remains technically difficult in cases with
obesity and/or a narrow pelvis. Recent randomized controlled trials (RCTs) (i.e., COLOR II and COREAN)
[2,3]
exhibited more favorable outcomes of laparoscopic rectal surgery compared with open rectal surgery ,
[4,5]
whereas other recent RCTs (i.e., ALaCaRT and ACOSOG Z6051) did not . In recent years, transanal
TME (taTME) surgery for rectal cancer has attracted intense attention due to the improvements in the

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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