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Laparoscopic Restorative Total Proctocolectomy with Mucosal Resection

  • Published:
Diseases of the Colon & Rectum

Purpose

Laparoscope-assisted restorative proctocolectomy is an alternative to conventional surgery for the treatment of ulcerative colitis. We present our approach of laparoscopic dissection and transection of rectum combined with transanal rectal mucosectomy.

Methods

A total of 21 patients underwent laparoscopic total proctocolectomy with transanal rectal mucosectomy for ulcerative colitis. The rectum was mobilized and transected by using a combination of laparoscopic dissection and trans-anal mucosectomy without hand-assist or mini-laparotomy. The extent of laparoscopic dissection and the transection method varied according to the difficulty of pelvic dissection or the surgeon’s experience (early-phase method: laparoscopic transection of the muscular-cuff after transanal mucosectomy; intermediate-phase method: transection of the posterior side transanally and anteriolateral side laparoscopically; and recent-phase method: laparoscopic dissection down to the pelvic outlet and transanal circumferential transection of the rectum after mucosectomy).

Results

Using this approach, the median operative time was 404 minutes and the median operative blood loss was 120 g. There was no operative mortality, and no patients reported sexual or urinary complications during short-term follow-up.

Conclusions

Laparoscopic total proctocolectomy for the treatment of ulcerative colitis is a feasible approach that demonstrates excellent views of the pelvis, which could be advantageous compared with conventional surgery. A step-by-step approach according to the surgeon’s experience and the difficulty of pelvic dissection may help minimize the risk of pelvic autonomic nerve injury.

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Authors and Affiliations

  1. Department of Surgery, Kyoto University Hospital, Kyoto, Japan

    Suguru Hasegawa M.D., Ph.D., Akinari Nomura M.D., Junichiro Kawamura M.D., Satoshi Nagayama M.D., Ph.D. & Yoshiharu Sakai M.D., Ph.D.

  2. Department of Surgery, Kyoto Medical Center, Kyoto, Japan

    Hiroaki Hata M.D. & Takashi Yamaguchi M.D.

  3. Department of Surgery, Cancer Institute Hospital, Tokyo, Japan

    Hiroya Kuroyanagi M.D.

  4. Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo, Kyoto, 606-8507, Japan

    Suguru Hasegawa M.D., Ph.D.

Authors
  1. Suguru Hasegawa M.D., Ph.D.
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  2. Akinari Nomura M.D.
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  3. Junichiro Kawamura M.D.
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  4. Satoshi Nagayama M.D., Ph.D.
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  5. Hiroaki Hata M.D.
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  6. Takashi Yamaguchi M.D.
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  7. Hiroya Kuroyanagi M.D.
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  8. Yoshiharu Sakai M.D., Ph.D.
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Corresponding author

Correspondence to Suguru Hasegawa M.D., Ph.D..

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Hasegawa, S., Nomura, A., Kawamura, J. et al. Laparoscopic Restorative Total Proctocolectomy with Mucosal Resection. Dis Colon Rectum 50, 1152–1156 (2007). https://doi.org/10.1007/s10350-007-0220-y

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  • DOI: https://doi.org/10.1007/s10350-007-0220-y

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