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Local Excision (LE) for Low Rectal Cancer (RC): From Mucosectomy to Endolumen Loco-Regional Resection (ELRR)—Tips and Tricks

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Single Incision Laparoscopic and Transanal Colorectal Surgery

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Abstract

Since 1992 we have introduced TEM technique in our institution and more than 950 operations have been performed for benign and malignant lesions of the rectum. To obtain good clinical results two conditions must be met: a correct patient selection and an adequate local exeresis with a correct surgical technique. TEM is a complex and difficult procedure that requires a specific skill that can be achieved only after prolonged training on the simulator. The correct patient position on the operative table is crucial to the success of the procedure. Technical characteristic of the electric scalpel is another important issue to pay attention to. The technical advantages of TEM instrumentation allow a precise dissection of the different layers of the rectum so that five different types of excision/resection can be performed: mucosectomy, inframuscolar layers dissection, full thickness excision, full thickness excision with partial exeresis of the perirectal mesorectum, and endoluminal loco-regional resection (ELRR).

During dissection, an opening of the peritoneal cavity can occur, but we never observed related postoperative complications; we recommend to close the opening immediately.

After the end of dissection in the specimen it is recommendable to wash the defect, to perform intraoperative histological evaluation of the rims, and nucleotide-guided mesorectal excision. This is an original technique developed with the purpose of increasing the number of removed nodes in order to evaluate if a salvage TME is necessary. To become a skilled of TEM technique, long training is requested. Microsurgery requires more delicate maneuvers and every risk of bleeding must be minimized. When large endoluminal resection of the rectum is performed like ELRR, the surgeon must be very prudent and must have a perfect control of instruments manipulation, especially in blind conditions related to bleedings that can occur during the dissection.

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Authors and Affiliations

  1. Department of General Surgery, University ‘Politecnica delle Marche’, Via Conca 71, 60126, Ancona, Italy

    Giovanni Lezoche M.D, Ph.D.

  2. Department of General Surgery, Surgical Specialities and Organ Transplantation, ‘Paride Stefanini’ at University of Rome, Rome, Italy

    Emanuele Lezoche M.D., F.A.C.S.

Authors
  1. Giovanni Lezoche M.D, Ph.D.
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  2. Emanuele Lezoche M.D., F.A.C.S.
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Correspondence to Emanuele Lezoche M.D., F.A.C.S. .

Editor information

Editors and Affiliations

  1. The University of Hong Kong, Queen Mary Hospital, Hong Kong, People's Republic of China

    Wai Lun Law

  2. Case Western Reserve University, University Hospitals Case Medical Center, Cleveland, Ohio, USA

    Conor P. Delaney

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Lezoche, G., Lezoche, E. (2014). Local Excision (LE) for Low Rectal Cancer (RC): From Mucosectomy to Endolumen Loco-Regional Resection (ELRR)—Tips and Tricks. In: Law, W., Delaney, C. (eds) Single Incision Laparoscopic and Transanal Colorectal Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8902-3_9

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  • DOI: https://doi.org/10.1007/978-1-4614-8902-3_9

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