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Laparoscopic Low Anterior Resection with Total Mesorectal Excision for Rectal Cancer
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* These authors contributed equally
In This Article
Summary
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.
Abstract
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.
Introduction
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 r....
Protocol
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
- Perform the procedure using routine general anesthesia10,11, including preparation for GI tract decompression (including a bowel preparation and nasogastric tube placement), neuromuscul.......
Representative Results
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 .......
Discussion
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.......
Acknowledgements
The study was supported by the China Scholarship Council (201306230127).
....Materials
| Name | Company | Catalog Number | Comments |
| Olympus- Laparoscopes Articulating HD 3D Videoscope ENDOEYE FLEX 3D | LTF-190-10-3D | ||
| Olympus-3D monitor | LMD-3251SC | ||
| Olympus -UHI-4 High Flow Insufflation Unit | UHI-4 | ||
| The Evis Exera III Video Center | CV-190 | ||
| The Evis Exera III Xenon Light Source | CLV-190 | ||
| The 3DV-190 3D visualization unit | 3DV-190 | ||
| Olympus -Image Management Hub 20 | Olympus -Image Management Hub 20 | ||
| Olympus30° laparoscope | WA 53005 A 30° | ||
| Sony LMD-3251SC | LMD-3251SC | ||
| Laparoscopic insufflation needle / Veress | MND11200 | ||
| 12mm ENDOPATH XCEL Bladeless Trocars | B12LT | ||
| 5mm ENDOPATH XCEL Bladeless Trocars | B5LT | ||
| HARMONIC ACE+ Shears HAR36 | HAR36 | ||
| HARMONIC Hand Pieces | HPO54 | ||
| Covidien – Medtronic Valleylab FT10 Energy Platform | VLFT10GEN | ||
| LigaSure 5 mm Blunt Tip Laparoscopic Instrument | LF1637 | ||
| Force FX-8C Electrosurgical Generator | Force FX-8C Electrosurgical Generator | ||
| ENDOPATH 5mm Curved Scissors | 5DCS | ||
| ENDOPATH 5mm Curved Dissector | 5DCD | ||
| Kangji Alligator Grasper Forceps(Φ5x330mm) | 101.044 | ||
| Kangji Fenestrated Grasper Forceps(Φ5x330mm) | 101.042 | ||
| Kangji Clip Applier | 101.1113A | ||
| Kangji intestinal grasper | Kangji intestinal grasper | ||
| Teleflex 544240 Weck Hem-o-lok Polymer Ligating Clips | Teleflex 544240 Weck | ||
| Covidien GIA 80-3.8mm Reloadable Stapler | GIA8038S | ||
| Medtronic Endo GIA Reloads with Tri-Staple Technology | Medtronic Endo GIA Reloads with Tri-Staple Technology | ||
| DST Series EEA Staplers 25 or 28mm | DST Series EEA Staplers 25 or 28mm | ||
| AMSINO Suction Kits | XY-23P |
References
- Heald, R. J., Husband, E. M., Ryall, R. D. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence. The British Journal of Surgery. 69 (10), 613-616 (1982).
- Bosset, J. F., et al. Chemotherapy with preoperativ....
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