Phd thesis

cover doctoral thesis

The Doctoral Thesis

The Doctoral Thesis of Joep Knol was titled “Transanal Total Mesorectal Excision – Safe Introduction Of A New Technique” and was successfully defended on 1th of February 2019 in Amsterdam.

The thesis was jointly supervised by the VU of Amsterdam (The Netherlands) and the UHasselt (Belgium).

Promotors: Prof. dr. Jaap Bonjer en prof. dr. Frank Vandenabeele
Co-promotor: dr. Colin Sietses

Prof. dr. Donald Van der Peet (chair)
Dr. Ingrid Arijs
Prof. dr. Nuno Figueiredo
Prof. dr. Hans de Wilt
Prof. dr. Willem Bemelman*

*Member of the reading committee

External members of the jury:
Prof. dr. Richard (Bill) Heald
Prof. dr. Antonio de Lacey

Dr. Lieven Herbots
Dr. Mathieu D'Hondt

picture joep knol and jury

Summary of the Thesis

While the treatment of rectal cancer is multimodal, above all a proper oncologic resection is critical.
The introduction and widespread education of total mesorectal excision (TME) have significantly impact on outcomes for rectal cancer surgery, and therefore the procedure has become the gold standard for curative resection of rectal cancer. The transanal total mesorectal excision (taTME) has been developed to overcome some of the problems that arise when operating deep down in the pelvis, aiming to achieve higher rates of complete specimens compared to abdominal TME. However this new and technically demanding procedure, requires a structured training and education for a safe implementation as part of a whole pathway.

Part 1 - TME en TaTME

Chapter 1. Total Mesorectal Excision Technique: Past, Present, and Future
Joep Knol, Deborah S Keller – Clinics of Colon and Rectal Surgery 2020, May

Part 2 Technical aspects of TaTME

Chapter 2. Transanal Total Mesorectal Excision: Technical aspects of approaching the mesorectal plane from below – A preliminary report
Joep Knol, Mathieu D’Hondt, Geert Souverijns, Richard J Heald, Guido Vangertruyden – Techn Coloproctology 2015, Apr

Chapter 3. Transanal Total Mesorectal Excision: Technical aspects of approaching the mesorectal plane from below
Joep Knol, Sami A Chadi – Minimal Invasive Therapy & Allied Technologies 2016, Oct

Chapter 4. Optimal dissection for Transanal TME using modified CO2 insufflation and smoke extraction
Gary Nicholson, Joep Knol, Bert Houben, Chris Cunningham, S Ashraf, Roel Hompes – Colorectal Disease 2015, Nov

Chapter 5. Operative vectors, anatomic distortion, and the inherent effects of pneumatic insufflation encountered during Transanal Total Mesorectal Excision
Sam Atallah, P Gonzalez, Sami A Chadi, Roel Hompes, Joep Knol – Techniques in Coloproctology 2017, Oct

Chapter 6. Four anastomotic techniques following Transanal Total Mesorectal Excision (TaTME)
Marta Penna, Joep Knol, Jurriaan Tuynman, Paris Tekkis, Neil Mortensen, Roel Hompes – Techn Coloproctol 2016, Mar

Chapter 7. Urethral injury and other urologic injuries during Transanal Total Mesorectal Excision, an international collaborative study
Patricia Sylla, Joep Knol, Anthony D’Andrea, Rodrigo Perez, Sam Atallah, Marta Penna, Roel Hompes, Albert Wolthuis, Philippe Rouanet, Abe Fingerhut, International Urethral Injury Collaborative – Annals of Surgery 2019, Sep

Part 3 Cognitive skills training of TaTME

Chapter 8. Cognitive skills training in digital era: a paradigm shift in surgical education using the taTME model
Joep Knol, Deborah Keller – The Surgeon 2019, Feb

Chapter 9. Laparoscopic mobilization of the splenic flexure: the use of color grading as a unique teaching tool
Joep Knol, Steven S Wexner, Guido Vangertruyden – Surgical Endoscopy 2015, Mar

Chapter 10. A new paradigm addressing the boundaries of live surgical education: synchronized deferred live surgery
Joep Knol, Jaap Bonjer, Bert Houben, Steven D Wexner, Roel Hompes, Sam Atallah, Richard J Heald, Colin Sietses, Sami A Chadi – Journal American College of Surgeons 2018, Oct