INTRODUCTION
In laparoscopic rectal tumor surgery, oncologic principles like total mesorectal excision and lymph node dissection have to be observed.
METHODS
The procedure is performed in a modified lithotomy position using five trocars. The inferior mesenteric artery is divided first close to the aorta dissecting all lymph nodes located along its trunk. Close to the ligament of Treitz, the inferior mesenteric vein is transected. The sigmoid and the descending colon are freed up laterally. The splenic flexure is mobilized completely with the lesser sac being opened. The rectum is mobilized posteriorly down to the pelvic floor and laterally on both sides, sparing the hypogastric nerves and observing the completeness of the fascia propia of the mesorectum. After further anterior mobilization, it is transected in its middle third using an articulating stapler. The descending colon is also transected intracorporeally. The specimen is transferred into a plastic bag which is pulled outside the peritoneal cavity through an incision of 3.5 cm. The colorectal anastomosis is established intracorporeally in a double-stapling technique.
RESULTS
The videotape reports about a 58-year-old female who had repeated anal bleeding. Proctoscopy and biopsy revealed a large sessile rectal adenoma larger than 5 cm at 10 cm from the anal verge, highly suspicious of carcinoma. There were no intraoperative or postoperative complications. The patient was discharged from the hospital on the 6th postoperative day.
CONCLUSION
In selected cases, laparoscopic oncologic low anterior resection of the rectum is technically safe and feasible according to the principles valid in conventional tumor surgery.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
Bruch HP, Schwandner O. Current status of laparoscopic surgery in colorectal cancer. Onkologie 2001;24:29-32.
Buchmann P. Standard technique of oncologic colorectal surgery. Swiss Surg 2003;9:140-4.
Hildebrandt U, Kreissler-Haag D, Lindemann W. Laparoscopy-assisted colorectal resections: morbidity, conversions, outcomes of a decade. Zentralbl Chir 2001;126:323-32.
Keller R, Roblick UJ, Schwandner O, Bruch HP. Laparoskopische therapie des kolorektalen karzinoms—wunschdenken oder realismus? Zentralbl Chir 2003;128:1080-5.
Kessler H, Jerby BL, Marcello PW, Gramlich T, Milsom JW. Laparoscopic total mesorectal excision and autonomic nerve preservation in a cadaver model. J Cancer Res Clin Oncol 1998;124(Suppl):R83.
Kessler H, Hohenberger W. Laparoscopic oncologic low anterior resection for neoplasia of the rectum. Arch Hung Med Assoc Am 2002;10:6.
Leroy J, Jamal F, Forbes R, et al. Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long-term outcomes. Surg Endosc 2004;18:281-9.
Liang JT, Lai HS, Huang KC, et al. Comparison of medial-to-lateral versus traditional lateral-to-medial laparoscopic dissection sequences for resection of rectosigmoid cancers: randomized controlled clinical trial. World J Surg 2003;27:1337-8; author reply 1338.
Morino M, Parini U, Giraudo G, et al. Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg 2003;237:335-42.
Patankar SK, Larach SW, Ferrara A, et al. Prospective comparison of laparoscopic vs. open resections for colorectal adenocarcinoma over a ten-year period. Dis Colon Rectum 2003;46:601-11.
Patankar SK, Lee W. Current status of laparoscopic resection for colorectal cancer. J Clin Gastroenterol 2004;38:621-7.
Watanabe M, Teramoto T, Hasegawa H, Kitajima M. Laparoscopic ultralow anterior resection combined with per anum intersphincteric rectal dissection for lower rectal cancer. Dis Colon Rectum 2000;43(10 Suppl):S94-7.
Weiser MR, Milsom JW. Laparoscopic total mesorectal excision with autonomic nerve preservation. Semin Surg Oncol 2000;19:396-403.
Yamamoto S, Watanabe M, Hasegawa H, Kitajima M. Prospective evaluation of laparoscopic surgery for rectosigmoidal and rectal carcinoma. Dis Colon Rectum 2002;45:1648-54.
Zhou ZG, Wang Z, Yu YY, et al. Laparoscopic total mesorectal excision of low rectal cancer with preservation of anal sphincter: a report of 82 cases. World J Gastroenterol 2003;9:1477-81.
Author information
Authors and Affiliations
Video
Video contribution
About this article
Cite this article
Kessler, H., Hohenberger, W. Laparoscopic Oncologic Low Anterior Resection of the Rectum. Dis Colon Rectum 48, 2341–2342 (2005). https://doi.org/10.1007/s10350-005-0184-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10350-005-0184-8