Skip to main content
Log in

A Standardized Technique for Laparoscopic Rectal Resection

  • 2008 SSAT Other
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Introduction

Laparoscopic rectal resection (LRR) has not gained the same acceptance as laparoscopic segmental colonic resection because of technical challenges, increased operating time and costs, and concerns about the oncological outcome.

Discussion

One way to overcome these challenges is by standardizing the laparoscopic technique in the same way as has been done with the open rectal cancer surgery. We have established a standardized, stepwise laparoscopic procedure for rectal resections that enhances the transformation of laparoscopic skills, identifies indications for conversion early in the operation, and makes the operation predictable and reproducible for the whole surgical team.

Conclusion

We believe this saves time in the operating room and builds up laparoscopic team expertise.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Cohen SM, Wexner SD. Laparoscopic colorectal resection for cancer: the Cleveland Clinic Florida experience. Surg Oncol. 1993;2(Suppl 1):35–42. doi:10.1016/0960-7404(93)90057-6.

    Article  PubMed  Google Scholar 

  2. Kim LH, Chung KE, AuBuchon P. Laparoscopic-assisted abdominoperineal resection with pull-through (sphincter saving). Surg Laparosc Endosc. 1992;2(3):237–240.

    CAS  PubMed  Google Scholar 

  3. Morino M, Parini U, Giraudo G, et al. Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg. 2003;237(3):335–342. doi:10.1097/00000658-200303000-00006.

    Article  PubMed  Google Scholar 

  4. Duluq JL, Wintringer P, Stabilini C, et al. Laparoscopic rectal resection with anal sphincter preservation for rectal cancer: long-term outcome. Surg Endosc 2005;19(11):1468–1474. doi:10.1007/s00464–005–0081–1.

    Article  Google Scholar 

  5. Leung KL, Kwok SP, Lam SCW, et al. Laparoscopic resection of rectosigmoid carcinoma: Prospective randomized trial. Lancet 2004;363:1187–1192. doi:10.1016/S0140-6736(04)15947-3.

    Article  PubMed  Google Scholar 

  6. Breukink S, Pierie J, Wiggers T. Laparoscopic versus open total mesorectal exicion for rectal cancer (Review). Cochrane Database Syst Rev 2006; (4):CD005200.

  7. Jayne DG, Guillou PJ, Thorpe H, et al. Randomized trial of laparoscopic assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASSIC trial group. J Clin Oncol. 2007;25:3061–3068. doi:10.1200/JCO.2006.09.7758.

    Article  PubMed  Google Scholar 

  8. Kuhry E, Schwenk WF, Gaupset R, Romild U, Bonjer HJ. Long-term results of laparoscopic colorectal cancer resection. Cochrane Database Syst Rev 2008;(2):CD003432.

  9. Senagore AJ, Duepree HJ, Delaney CP, et al. Results of a standardized technique and postoperative care plan for laparoscopic sigmoid colectomy. A 30-month experience. Dis Colon Rectum. 2003;46:503–509. doi:10.1007/s10350-004-6590-5.

    Article  PubMed  Google Scholar 

  10. Delaney CP, Kiran RP, Senagore AJ, et al. Case matched comparison of clinical and financial outcome after laparoscopic or open colectomy. Ann Surg. 2003;238:67–72. doi:10.1097/00000658-200307000-00009.

    Article  PubMed  Google Scholar 

  11. Braga M, Frasson M, Vignali A, et al. Laparoscopic resection in rectal cancer patients: Outcome and cost-benefit analysis. Dis Colon Rectum. 2007;50:464–471. doi:10.1007/s10350-006-0798-5.

    Article  PubMed  Google Scholar 

  12. Delaney CP. Low anterior resection. In: van Heerden F et al., editors. Operative techniques in general surgery. Philadelphia: Saunders; 2003. p. 214–223.

  13. Kariv Y, Delaney CP, Senagore AJ, et al. Clinical outcome and cost analysis of a “fast track” postoperative care pathway for ileal pouch-anal anastomosis: a case control study. Dis Colon Rectum. 2007;50(2):137–146. doi:10.1007/s10350-006-0760-6.

    Article  PubMed  Google Scholar 

  14. Senagore AJ, Delaney CP. A critical analysis of laparoscopic colectomy at a single institution: lessons learned after 1000 cases. Am J Surg. 2006;191:377–380. doi:10.1016/j.amjsurg.2005.10.039.

    Article  PubMed  Google Scholar 

  15. Kim SH, Park IJ, Joh YG, et al. Laparoscopic resection for rectal cancer: a prospective analysis of thirty-month follow-up outcomes in 312 patients. Surg Endosc. 2006;20(8):1197–202. doi:10.1007/s00464-005-0599-2.

    Article  PubMed  Google Scholar 

  16. Maslekar S, Sharma A, MacDonald A. Mesorectal grades predict recurrences after curative resection for rectal cancer. Dis Colon Rectum. 2006;50:168–175. doi:10.1007/s10350–006–0756–2.

    Article  Google Scholar 

  17. Quirke P, Dixon MF. The prediction of local recurrence in rectal adenocarcinoma by histopathologic examination. Int J Colorectal Dis. 1988;3:127–131. doi:10.1007/BF01645318.

    Article  CAS  PubMed  Google Scholar 

  18. Quirke P, Dixon MF. The prediction of local recurrence in rectal adenocarcinoma by histopathologic examination. Int J Colorectal Dis. 1988;3:127–131. doi:10.1007/BF01645318.

    Article  CAS  PubMed  Google Scholar 

  19. Birbeck KF, Macklin CP, Tiffin NJ, et al. Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg. 2002;235(4):449–457. doi:10.1097/00000658-200204000-00001.

    Article  PubMed  Google Scholar 

  20. Nagtegaal ID, Marjinen CA, Kranenbarg EK, et al. Circumferential resection margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimetre but two millimetres is the limit. Am J Surg Pathol. 2002;26(3):350–357. doi:10.1097/00000478-200203000-00009.

    Article  PubMed  Google Scholar 

  21. Wibe A, Rendedal PR, Svensson E, et al. Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. Br J Surg. 2002;89:327–334. doi:10.1046/j.0007-1323.2001.02024.x.

    Article  CAS  PubMed  Google Scholar 

  22. Guillou PJ, Quirke P, Thorpe H, et al. Short term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASSIC trial):Multicentre, randomised controlled trial. Lancet 2005;365:1718–1726. doi:10.1016/S0140-6736(05)66545-2.

    Article  PubMed  Google Scholar 

  23. Tekkis PP, Senagore AJ, Delaney CP, et al. Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right sided and left sided resections. Ann Surg. 2005;242(1):83–91. doi:10.1097/01.sla.0000167857.14690.68.

    Article  PubMed  Google Scholar 

  24. Casillas S, Delaney CP, Senagore AJ, et al. Does conversion of a laparoscopic colectomy adversely affect patient outcome? Dis Colon Rectum. 2004;47(10):1680–1685. doi:10.1007/s10350–004–0692–4.

    Article  PubMed  Google Scholar 

  25. Lindsetmo RO, Champagne B, Delaney CP. Laparoscopic rectal resections and fast track surgery: what can be expected? Am J Surg 2009;197:408–412.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Conor P. Delaney.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lindsetmo, RO., Delaney, C.P. A Standardized Technique for Laparoscopic Rectal Resection. J Gastrointest Surg 13, 2059–2063 (2009). https://doi.org/10.1007/s11605-009-1033-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-009-1033-1

Keywords

Navigation