Transperineal approach alone as minimally invasive surgery for pelvic recurrence of rectal cancer after abdominoperineal resection

Transperineal approach alone as minimally invasive surgery for pelvic recurrence of rectal cancer after abdominoperineal resection | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Method Article Transperineal approach alone as minimally invasive surgery for pelvic recurrence of rectal cancer after abdominoperineal resection Takuya Tokunaga, Hideya Kashikara, Toshiaki Yoshimoto, Daichi Ishikawa, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5653986/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 05 May, 2025 Read the published version in Techniques in Coloproctology → Version 1 posted 9 You are reading this latest preprint version Abstract Introduction: In this report, we describe a case of pelvic recurrence of rectal cancer invading a seminal vesicle after abdominoperineal resection, which was removed only by a transperineal approach with the addition of urethrography. Case: The patient, a man in his 60s, underwent laparoscopic abdominoperineal resection for lower rectal cancer at another hospital. Thirty months after the surgery, he was referred to our department for surgery for a recurrent tumor in the pelvis. Magnetic resonance imaging showed a tumor on the dorsal prostate that was suspected to have invaded a seminal vesicle. Surgical findings: After incision in the previous perineal surgical wound, a subcutaneous incision was made and a GelPOINT mini was attached. Airflow was applied with the AirSeal system, and the surgery was performed laparoscopically. To accurately identify the dissection layers and avoid urethral injury, intraoperative urethrography was performed as necessary, and dissection was performed with an electrocautery and ultrasonic coagulation incision device while confirming the position of the urethra and forceps. The prostate was safely identified by urethrography and separated from the firm tumor. After dissecting the fatty tissue surrounding the tumor, the affected seminal vesicle was partially resected. The dorsal side of the tumor was dissected using the coccygeal bone and the levator ani muscle as guides, and the tumor was removed. Conclusion: In select cases, the TaTME technique may allow minimally invasive surgery using only a transanal or transperineal approach. Introduction Pelvic recurrence of rectal cancer often requires invasive surgery, such as total pelvic visceral excision, that can lead to problems, such as adhesions associated with reoperation, increased operation time and blood loss, and functional impairment caused by the combined resection of other organs. The two-team approach with transanal total mesorectal excision (TaTME) for recurrent tumors is useful and provides a good visual field unaffected by previous surgery and shortens the operative time (1–3). We have previously reported that urethrography in TaTME is useful to determine the appropriate dissection line (4). In this report, we describe a case of pelvic recurrence of rectal cancer invading a seminal vesicle after abdominoperineal resection, which was removed only by a transperineal approach with the addition of urethrography. Case The patient, a man in his 60s, underwent laparoscopic abdominoperineal resection for lower rectal cancer at another hospital. Thirty months after the surgery, he was referred to our department for surgery for a recurrent tumor in the pelvis. Magnetic resonance imaging showed a tumor on the dorsal prostate that was suspected to have invaded a seminal vesicle. The tumor shrunk after chemotherapy with FOLFIRI (irinotecan 180 mg/m 2 , leucovorin 200 mg/m 2 intravenously, bolus 5-fluorouracil 400 mg/m 2 , and 5-fluorouracil infusion at 2400 mg/m 2 /46 h) + panitumumab. Because the small intestine had dropped into the pelvis and extensive adhesions were expected in the abdominal cavity, a transperineal approach was planned, and the affected seminal vesicle was scheduled for partial combined resection. Surgical findings After incision in the previous perineal surgical wound, a subcutaneous incision was made and a GelPOINT mini (Applied Medical Japan Headquarters, Tokyo, Japan) was attached. Airflow was applied with the AirSeal system (Conmed, Utica, NY, USA), and the surgery was performed laparoscopically. First, ventral dissection was initiated. To accurately identify the dissection layers and avoid urethral injury, intraoperative urethrography was performed as necessary, and dissection was performed with an electrocautery and ultrasonic coagulation incision device while confirming the position of the urethra and forceps. The prostate was safely identified by urethrography and separated from the firm tumor. After dissecting the fatty tissue surrounding the tumor, the affected seminal vesicle was partially resected. The dorsal side of the tumor was dissected using the coccygeal bone and the levator ani muscle as guides, and the tumor was removed. A drain was inserted through the gluteal region into the pelvic floor, and the skin was sutured closed. There was no intraoperative injury to other organs, such as the small intestine, and the surgery was completed using only a transperineal approach. The surgery time was 134 minutes, with only 5 ml of blood loss. There were no postoperative complications, and the patient was discharged 8 days after the surgery. Histopathological examination indicated negative circumferential resection margins, and no local recurrence was observed 18 months after surgery. Discussion In surgery for recurrent tumors of rectal cancer, a transanal or transperineal endoscopic approach provides a good surgical view that is less affected by previous surgery. The TaTME technique allows for a deep pelvic approach without laparotomy, making it possible to perform minimally invasive surgery in patients with expected intraperitoneal adhesions or poor general condition. However, a transanal or transperineal approach requires an understanding of the unique anatomy, which may be even more difficult in reoperation. In male patients, the use of intraoperative urethrography reduces the risk of urethral injury because the position of the forceps can be determined in real time. However, there are limitations to this approach. In post-abdominoperineal resection case s, care must be taken if the small intestine has dropped to the deepest pelvic region, as adhesion of the small intestine may be a problem even with a transperineal approach. Additionally, owing to the limited extent of resection, care must be taken to ensure negative circumferential resection margins. In conclusion, in select cases, the TaTME technique may allow minimally invasive surgery using only a transanal or transperineal approach. Declarations Funding All authors declare that they have received no funding support for this research. Ethics declarations The manuscript complies with ethics requirements. Conflict of interest The authors declare that they have no conflict of interest. Submission declaration The authors declare that the work described has not been published previously, that it is not under consideration for publication elsewhere, and that its publication is approved by all authors. Ethical approval and Informed Consent This study was approved by the Tokushima University Hospital Ethics Committee and the corresponding regulatory agencies. All experiments were performed in accordance with the approved guidelines (Tokushima Clinical Trial Management System Number; 3215). Informed consent was obtained from the patient for the publication of this report and related images. As an additional ethical consideration, all patient information has been removed from the images and published materials. Patient consent The patient provided informed consent for the publication of this report and associated images. Authors’ contributions : Conception and design: Takuya Tokunaga, Hideya Kashihara, Toshiaki Yoshimoto, and Daichi Ishikawa. Drafting of the article: Takuya Tokunaga, Masaaki Nishi, Chie Takasu, Yuma Wada and Chiharu Nakasu. Final approval of the article: Takuya Tokunaga and Mitsuo Shimada. Acknowledgments We thank Jane Charbonneau, DVM, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript. References Uehara K, Ogura A, Murata Y, Sando M, Mukai T, Aiba T, Yamamura T, Nakamura M. (2023) Current status of transanal total mesorectal excision for rectal cancer and the expanding indications of the transanal approach for extended pelvic surgeries. Dig Endosc Jan;35(2):243-254 Hasegawa S, Kajitani R, Matsumoto Y, Ohmiya T, Nagano H, Komono A, Aisu N, Yoshimatsu G, Yoshida Y. (2020) Combined laparoscopic and transperineal endoscopic total pelvic exenteration for local recurrence of rectal cancer. Tech Coloproctol Jun;24(6):599-601 Kimura K, Ikeda M, Kataoka K, Beppu N, Uchino M, Yamano T, Ikeuchi H, Tomita N. (2020) Sacrectomy for Recurrent Rectal Cancer Using the Transanal Total Mesorectum Excision Technique. Dis Colon Rectum Dec;63(12):e566-e573 Tokunaga T, Higashijima J, Yoshikawa K, Nishi M, Kashihara H, Takasu C, Shimada M. (2020) The usefulness of intraoperative X-ray fluoroscopy in avoiding urethral injury during transanal total mesorectal excision.Asian J Endosc Surg Apr;13(2):242-245 Link to the video at Fighsare https://figshare.com/articles/thesis/Transperineal_approach_alone_as_minimally_invasive_surgery_ for_pelvic_recurrence_of_rectal_cancer_after_abdominoperineal_resection/27214617?file=49754898 Additional Declarations No competing interests reported. Supplementary Files video.mp4 Cite Share Download PDF Status: Published Journal Publication published 05 May, 2025 Read the published version in Techniques in Coloproctology → Version 1 posted Editorial decision: Revision requested 11 Feb, 2025 Reviews received at journal 30 Jan, 2025 Reviews received at journal 24 Jan, 2025 Reviewers agreed at journal 20 Jan, 2025 Reviewers agreed at journal 07 Jan, 2025 Reviewers invited by journal 07 Jan, 2025 Editor assigned by journal 23 Dec, 2024 Submission checks completed at journal 17 Dec, 2024 First submitted to journal 16 Dec, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5653986","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Method Article","associatedPublications":[],"authors":[{"id":391390033,"identity":"ca842163-63a4-4855-bb94-abe77cc3d0c1","order_by":0,"name":"Takuya 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of rectal cancer often requires invasive surgery, such as total pelvic visceral excision, that can lead to problems, such as adhesions associated with reoperation, increased operation time and blood loss, and functional impairment caused by the combined resection of other organs. The two-team approach with transanal total mesorectal excision (TaTME) for recurrent tumors is useful and provides a good visual field unaffected by previous surgery and shortens the operative time (1\u0026ndash;3). We have previously reported that urethrography in TaTME is useful to determine the appropriate dissection line (4). In this report, we describe a case of pelvic recurrence of rectal cancer invading a seminal vesicle after abdominoperineal resection, which was removed only by a transperineal approach with the addition of urethrography.\u003c/p\u003e"},{"header":"Case","content":"\u003cp\u003eThe patient, a man in his 60s, underwent laparoscopic abdominoperineal resection for lower rectal cancer at another hospital. Thirty months after the surgery, he was referred to our department for surgery for a recurrent tumor in the pelvis. Magnetic resonance imaging showed a tumor on the dorsal prostate that was suspected to have invaded a seminal vesicle. The tumor shrunk after chemotherapy with FOLFIRI (irinotecan 180 mg/m\u003csup\u003e2\u003c/sup\u003e, leucovorin 200 mg/m\u003csup\u003e2\u003c/sup\u003e intravenously, bolus 5-fluorouracil 400 mg/m\u003csup\u003e2\u003c/sup\u003e, and 5-fluorouracil infusion at 2400 mg/m\u003csup\u003e2\u003c/sup\u003e/46 h)\u0026thinsp;+\u0026thinsp;panitumumab. Because the small intestine had dropped into the pelvis and extensive adhesions were expected in the abdominal cavity, a transperineal approach was planned, and the affected seminal vesicle was scheduled for partial combined resection.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSurgical findings\u003c/h2\u003e \u003cp\u003eAfter incision in the previous perineal surgical wound, a subcutaneous incision was made and a GelPOINT mini (Applied Medical Japan Headquarters, Tokyo, Japan) was attached. Airflow was applied with the AirSeal system (Conmed, Utica, NY, USA), and the surgery was performed laparoscopically. First, ventral dissection was initiated. To accurately identify the dissection layers and avoid urethral injury, intraoperative urethrography was performed as necessary, and dissection was performed with an electrocautery and ultrasonic coagulation incision device while confirming the position of the urethra and forceps. The prostate was safely identified by urethrography and separated from the firm tumor. After dissecting the fatty tissue surrounding the tumor, the affected seminal vesicle was partially resected. The dorsal side of the tumor was dissected using the coccygeal bone and the levator ani muscle as guides, and the tumor was removed. A drain was inserted through the gluteal region into the pelvic floor, and the skin was sutured closed. There was no intraoperative injury to other organs, such as the small intestine, and the surgery was completed using only a transperineal approach. The surgery time was 134 minutes, with only 5 ml of blood loss. There were no postoperative complications, and the patient was discharged 8 days after the surgery. Histopathological examination indicated negative circumferential resection margins, and no local recurrence was observed 18 months after surgery.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn surgery for recurrent tumors of rectal cancer, a transanal or transperineal endoscopic approach provides a good surgical view that is less affected by previous surgery. The TaTME technique allows for a deep pelvic approach without laparotomy, making it possible to perform minimally invasive surgery in patients with expected intraperitoneal adhesions or poor general condition. However, a transanal or transperineal approach requires an understanding of the unique anatomy, which may be even more difficult in reoperation. In male patients, the use of intraoperative urethrography reduces the risk of urethral injury because the position of the forceps can be determined in real time. However, there are limitations to this approach. In post-abdominoperineal resection \u003cspan refid=\"Sec2\" class=\"InternalRef\"\u003ecase\u003c/span\u003es, care must be taken if the small intestine has dropped to the deepest pelvic region, as adhesion of the small intestine may be a problem even with a transperineal approach. Additionally, owing to the limited extent of resection, care must be taken to ensure negative circumferential resection margins. In conclusion, in select cases, the TaTME technique may allow minimally invasive surgery using only a transanal or transperineal approach.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare that they have received no funding support for this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe manuscript complies with ethics requirements.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubmission declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the work described has not been published previously, that it is not under consideration for publication elsewhere, and that its publication is approved by all authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and Informed Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Tokushima University Hospital Ethics Committee and the corresponding regulatory agencies. All experiments were performed in accordance with the approved guidelines (Tokushima Clinical Trial Management System Number; 3215). Informed consent was obtained from the patient for the publication of this report and related images. As an additional ethical consideration, all patient information has been removed from the images and published materials.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient provided informed consent for the publication of this report and associated images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eConception and design: Takuya Tokunaga, Hideya Kashihara, Toshiaki Yoshimoto, and Daichi Ishikawa.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDrafting of the article: Takuya Tokunaga, Masaaki Nishi, Chie Takasu, Yuma Wada and Chiharu Nakasu.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFinal approval of the article: Takuya Tokunaga and Mitsuo Shimada.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Jane Charbonneau, DVM, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eUehara K, Ogura A, Murata Y, Sando M, Mukai T, Aiba T, Yamamura T, Nakamura M. (2023) Current status of transanal total mesorectal excision for rectal cancer and the expanding indications of the transanal approach for extended pelvic surgeries. Dig Endosc Jan;35(2):243-254\u003c/li\u003e\n \u003cli\u003eHasegawa S, Kajitani R, Matsumoto Y, Ohmiya T, Nagano H, Komono A, Aisu N, Yoshimatsu G, Yoshida Y. (2020) Combined laparoscopic and transperineal endoscopic total pelvic exenteration for local recurrence of rectal cancer. Tech Coloproctol Jun;24(6):599-601\u003c/li\u003e\n \u003cli\u003eKimura K, Ikeda M, Kataoka K, Beppu N, Uchino M, Yamano T, Ikeuchi H, Tomita N. (2020) Sacrectomy for Recurrent Rectal Cancer Using the Transanal Total Mesorectum Excision Technique. Dis Colon Rectum Dec;63(12):e566-e573\u003c/li\u003e\n \u003cli\u003eTokunaga T, Higashijima J, Yoshikawa K, Nishi M, Kashihara H, Takasu C, Shimada M. (2020) The usefulness of intraoperative X-ray fluoroscopy in avoiding urethral injury during transanal total mesorectal excision.Asian J Endosc Surg Apr;13(2):242-245\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eLink to the video at Fighsare\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ehttps://figshare.com/articles/thesis/Transperineal_approach_alone_as_minimally_invasive_surgery_\u003cbr\u003efor_pelvic_recurrence_of_rectal_cancer_after_abdominoperineal_resection/27214617?file=49754898\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"techniques-in-coloproctology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"tcol","sideBox":"Learn more about [Techniques in Coloproctology](http://link.springer.com/journal/10151)","snPcode":"10151","submissionUrl":"https://submission.nature.com/new-submission/10151/3","title":"Techniques in Coloproctology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5653986/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5653986/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e In this report, we describe a case of pelvic recurrence of rectal cancer invading a seminal vesicle after abdominoperineal resection, which was removed only by a transperineal approach with the addition of urethrography.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase:\u003c/strong\u003e The patient, a man in his 60s, underwent laparoscopic abdominoperineal resection for lower rectal cancer at another hospital. Thirty months after the surgery, he was referred to our department for surgery for a recurrent tumor in the pelvis. Magnetic resonance imaging showed a tumor on the dorsal prostate that was suspected to have invaded a seminal vesicle.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical findings:\u003c/strong\u003e After incision in the previous perineal surgical wound, a subcutaneous incision was made and a GelPOINT mini was attached. Airflow was applied with the AirSeal system, and the surgery was performed laparoscopically. To accurately identify the dissection layers and avoid urethral injury, intraoperative urethrography was performed as necessary, and dissection was performed with an electrocautery and ultrasonic coagulation incision device while confirming the position of the urethra and forceps. The prostate was safely identified by urethrography and separated from the firm tumor. After dissecting the fatty tissue surrounding the tumor, the affected seminal vesicle was partially resected. The dorsal side of the tumor was dissected using the coccygeal bone and the levator ani muscle as guides, and the tumor was removed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eIn select cases, the TaTME technique may allow minimally invasive surgery using only a transanal or transperineal approach.\u003c/p\u003e","manuscriptTitle":"Transperineal approach alone as minimally invasive surgery for pelvic recurrence of rectal cancer after abdominoperineal resection","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-19 09:11:11","doi":"10.21203/rs.3.rs-5653986/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-02-11T18:24:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-30T20:41:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-24T08:35:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"68356039920759738621940862170532387118","date":"2025-01-20T15:27:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"229726538802114822761307074202473244769","date":"2025-01-07T17:19:58+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-01-07T11:28:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-12-23T17:11:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-12-17T12:07:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"Techniques in Coloproctology","date":"2024-12-16T12:45:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"techniques-in-coloproctology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"tcol","sideBox":"Learn more about [Techniques in Coloproctology](http://link.springer.com/journal/10151)","snPcode":"10151","submissionUrl":"https://submission.nature.com/new-submission/10151/3","title":"Techniques in Coloproctology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"b6c7527c-2a5e-4ee9-9cce-2849c6aedc16","owner":[],"postedDate":"December 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-12T16:04:30+00:00","versionOfRecord":{"articleIdentity":"rs-5653986","link":"https://doi.org/10.1007/s10151-025-03147-x","journal":{"identity":"techniques-in-coloproctology","isVorOnly":false,"title":"Techniques in Coloproctology"},"publishedOn":"2025-05-05 15:56:55","publishedOnDateReadable":"May 5th, 2025"},"versionCreatedAt":"2024-12-19 09:11:11","video":"","vorDoi":"10.1007/s10151-025-03147-x","vorDoiUrl":"https://doi.org/10.1007/s10151-025-03147-x","workflowStages":[]},"version":"v1","identity":"rs-5653986","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5653986","identity":"rs-5653986","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}