Name: laparoscopic low anterior resection with total mesorectal excision for rectal cancer
Uploaded: 2018-01-19T14:38:00
Description: Over the last few decades, laparoscopic total mesorectum excision has become a common procedure used in the treatment of stage I-III rectal cancers. When ...

The study was supported by the China Scholarship Council (201306230127).

This protocol was performed according to the ethical guidelines of the Declaration of Helsinki and approved by the Ethics Committee of Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine.
1. Preparation for Surgery
<ol>
	<li>Perform the procedure using routine general anesthesia10,11, including preparation for GI tract decompression (including a bowel preparation and nasogastric tube placement), neuromuscul...

<ol>
	<li>Heald, R. J., Husband, E. M., Ryall, R. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+mesorectum+in+rectal+cancer+surgery-the+clue+to+pelvic+recurrence.">The mesorectum in rectal cancer surgery-the clue to pelvic recurrence.</a> The British Journal of Surgery. 69 (10), 613-616 (1982).</li><li>Bosset, J. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chemotherapy+with+preoperative+radiotherapy+in+rectal+cancer.">Chemotherapy with preoperative radiotherapy in rectal cancer.</a> The New England Journal of Medicine. 355 (11), 1114-1123 (2006).</li><li>Akagi, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Multivariate+evaluation+of+the+technical+difficulties+in+performing+laparoscopic+anterior+resection+for+rectal+cancer.">Multivariate evaluation of the technical difficulties in performing laparoscopic anterior resection for rectal cancer.</a> Surgical Laparoscopy, Endoscopy &amp; Percutaneous Techniques. 22, 52-57 (2012).</li><li>Qu, H., Du, Y. F., Li, M. Z., Zhang, Y. D., Shen, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopy-assisted+posterior+low+anterior+resection+of+rectal+cancer.">Laparoscopy-assisted posterior low anterior resection of rectal cancer.</a> BMC Gastroenterology. 14, 158 (2014).</li><li>Ng, S. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quality+of+life+after+laparoscopic+vs+open+sphincter-preserving+resection+for+rectal+cancer.">Quality of life after laparoscopic vs open sphincter-preserving resection for rectal cancer.</a> World Journal of Gastroenterology. 19 (29), 4764-4773 (2013).</li><li>Liu, L. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anorectal+functional+outcome+following+laparoscopic+low+anterior+resection+for+rectal+cancer.">Anorectal functional outcome following laparoscopic low anterior resection for rectal cancer.</a> Molecular and Clinical Oncology. 6 (4), 613-621 (2017).</li><li>Agha, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+oncologic+outcome+after+laparoscopic+surgery+for+rectal+cancer.">Long-term oncologic outcome after laparoscopic surgery for rectal cancer.</a> Surgical Endoscopy and Other Interventional Techniques. 28 (4), 1119-1125 (2014).</li><li>Quirke, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+the+plane+of+surgery+achieved+on+local+recurrence+in+patients+with+operable+rectal+cancer:+a+prospective+study+using+data+from+the+MRC+CR07+and+NCIC-CTG+CO16+randomised+clinical+trial.">Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial.</a> The Lancet. 373 (9666), 821-828 (2009).</li><li>Jeong, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Open+versus+laparoscopic+surgery+for+mid-rectal+or+low-rectal+cancer+after+neoadjuvant+chemoradiotherapy+(COREAN+trial):+survival+outcomes+of+an+open-label,+non-inferiority,+randomised+controlled+trial.">Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial.</a> Lancet Oncology. 15 (7), 767-774 (2014).</li><li>Joshi, G. 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Best Practice &amp; Research.</a> Clinical Anaesthesiology. 28 (3), 261-273 (2014).</li><li>Gerges, F. J., Kanazi, G. E., Jabbourkhoury, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anesthesia+for+laparoscopy:+A+review.">Anesthesia for laparoscopy: A review.</a> Journal of Clinical Anesthesia. 18 (1), 67-78 (2006).</li><li>Currie, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+impact+of+enhanced+recovery+protocol+compliance+on+elective+colorectal+cancer+resection+results+from+an+international+registry.">The impact of enhanced recovery protocol compliance on elective colorectal cancer resection results from an international registry.</a> Annals of Surgery. 261 (6), 1153-1159 (2015).</li><li>Ong, C. K., Seymour, R. A., Lirk, P., Merry, A. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Combining+paracetamol+(acetaminophen)+with+nonsteroidal+anti-inflammatory+drugs:+a+qualitative+systematic+review+of+analgesic+efficacy+for+acute+postoperative+pain.">Combining paracetamol (acetaminophen) with nonsteroidal anti-inflammatory drugs: a qualitative systematic review of analgesic efficacy for acute postoperative pain.</a> Anesthesia &amp; Analgesia. 110 (4), 1170-1179 (2010).</li><li>Feng, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+outcomes,+and+propensity+score+matching+analysis:+rectal+cancer+resection+for+patients+with+elevated+preoperative+risk.">Long-term outcomes, and propensity score matching analysis: rectal cancer resection for patients with elevated preoperative risk.</a> Oncotarget. 8 (15), 25679 (2017).</li><li>Bonjer, H. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+randomized+trial+of+laparoscopic+versus+open+surgery+for+rectal+cancer.">A randomized trial of laparoscopic versus open surgery for rectal cancer.</a> New England Journal of Medicine. 372 (14), 1324-1332 (2015).</li><li>Jeong, S. 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L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+follow-up+of+the+Medical+Research+Council+CLASICC+trial+of+conventional+versus+laparoscopically+assisted+resection+in+colorectal+cancer.">Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer.</a> British Journal of Surgery. 100 (1), 75-82 (2013).</li><li>Mohamed, Z. K., Law, W. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+outcome+of+tumor-specific+mesorectal+excision+for+rectal+cancer:+the+impact+of+laparoscopic+resection.">The outcome of tumor-specific mesorectal excision for rectal cancer: the impact of laparoscopic resection.</a> World Journal of Surgery. 38 (8), 2168-2174 (2014).</li><li>Lu, A. 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Over the last three decades, total mesorectum excision (TME) was considered the gold standard for rectal cancer resection. Currently, it has been found by several randomized clinical trials that the oncological outcomes and long-term survival rates were equivalent between open and laparoscopic TME in the treatment of rectal cancer17,18,19. In addition, shorter hospitalization and faster recovery, lower blood loss and lower compl...

In 1982, total mesorectal excision (TME) was introduced by a British surgeon, Heald1, entailing an entire removal of the mesorectum, an adipose lymphatic tissue covering the rectum. Subsequently, low anterior resection (LAR) has become the preferred method for patients with rectal carcinoma, as opposed to abdominoperineal resection (APR), as LAR can preserve the sphincter.
Although radiotherapy and chemotherapy have significantly improved during the last few decades, appropriate surgical resection of the primary tumor remains the mainstay of curative treatments2. The anatomic position of the rectum makes TME via an anterior approach more difficult due to limited visualization of the lower pelvis3,4.
Compared to open surgery, laparoscopic surgery has recently been proven to be a feasible alternative option for rectal carcinoma in terms of equalized oncological outcome. Additionally, laparoscopic LAR (LLAR) is suggested to be superior to conventional open surgery due to less blood loss, less pain, and a shorter hospital stay5,6. During an LLAR operation, the lesion is removed, the right planes are detected, and the hypogastric nerves and lumbar splanchnic nerves are well preserved. Thus, during the past two decades, the outcome of rectal resection for rectal carcinoma has been substantially improved7. With the development of the laparoscopic device, to date, laparoscopic total mesorectal excision has become an alternative approach to open surgery in patients with rectal cancer. The oncological outcome has also been confirmed by several high-level pieces of evidence8,9. The present work aims to describe a laparoscopic low anterior resection approach to remove a part of the rectum containing carcinoma.

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			<td>101.044</td>
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			<td>Kangji intestinal grasper&#160;</td>
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			<td height="63" style="height:63px;">Teleflex 544240 Weck&#160; Hem-o-lok&#160; Polymer Ligating Clips&#160;</td>
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			<td>Teleflex 544240 Weck&#160;</td>
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			<td>GIA8038S</td>
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			<td height="91" style="height:91px;">Medtronic Endo GIA Reloads with Tri-Staple Technology&#160;</td>
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			<td>Medtronic Endo GIA Reloads with Tri-Staple Technology&#160;</td>
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			<td height="52" style="height:52px;">DST Series EEA Staplers 25 or 28mm&#160;</td>
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			<td>DST Series EEA Staplers 25 or 28mm&#160;</td>
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			<td>XY-23P&#160;</td>
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laparoscopic low anterior resection with total mesorectal excision for rectal cancer

Over the last few decades, laparoscopic total mesorectum excision has become a common procedure used in the treatment of stage I-III rectal cancers. When the tumor is located in the upper part of the rectum, low anterior resection (LAR) can be performed to remove the part of the rectum containing the tumor. In addition, faster recovery, less blood loss, and lower complications rates have been achieved by laparoscopic approach. In this protocol, the laparoscopic low anterior resection is performed through five cannulas. The rectum is mobilized with laparoscopic devices such as laparoscopic shears. The visceral and parietal pelvic fascia are dissected without injuring the hypogastric nerves and pelvic neurovascular bundles. The part of the rectum containing the tumor is removed and the colon is then attached to the remaining part of the rectum.

Intraoperative data 
In this protocol, the surgeon selected the medial side approach. The anterior wall of the rectum was lifted up to extend the right-side peritoneum of the rectum. The surgeon used an ultrasonic shear to dissect the peritoneum at promontory level along the concave of peritoneum and toward the peritoneal reflection (Figure 1A). In this protocol, the surgeon used sharp and blunt dissection to incise the ...

Laparoscopic low anterior resection with total mesorectum excision is a common procedure used in the treatment of stage I-III rectal cancers. The aim of this work is to describe a laparoscopic low anterior resection approach to remove the part of the rectum containing rectal cancer.

Laparoscopic Low Anterior Resection with Total Mesorectal Excision for Rectal Cancer

Over the last few decades, laparoscopic total mesorectum excision has become a common procedure used in the treatment of stage I-III rectal cancers. When ...