Standardization of Laparoscopic Low Anterior Resection

Akiyoshi Kanazawa, MD PhD, Akio Nakajima, MD PhD, Hiroyuki Hashi, MD PhD, Akira Arimoto, MD PhD, Yukihiro Kohno, MD PhD. Dept. Surgery, Osaka Red-cross Hospital

Introduction: A correct surgical procedure to rectal cancer has to make due allowance for both improved overall survival with local control of disease and preservation of the sphincter and urinary functions. Laparoscopic approach for rectal cancer has good operative view that has obvious advantage for improvement of operative procedure and education. We addressed standardization of laparoscopic total mesorectal excision (TME) and anastomotic technique.
Methods: Between January 2007 and August 2010, 201 cases laparoscopic resection for rectal cancer was performed in our hospital. We routinely performed autonomic nerve-sparing TME with left colic artery preserving for good blood supply of anastomosis. In the case of lower rectal cancer with mp or deeper invasion of main tumor, we performed preoperative radiation (2 Gy X 20 days, total 40 Gy) applied to patients three to four weeks before radical operation. For the reproducible operation, the important points are as follows: 1) symmetrical five-port system 2) making premeditated operative field with same instruments and view angle, 3) precise role of assistant, 4) enough rectal mobilization of rectum for cutting distal side of tumor.
Results: laparoscopic low anterior resection: one hundred forty-one cases, Laparoscopic intersphincteric resection: 11 cases, laparoscopic abdominoperineal resection: 14 cases were performed. Only one case of anastomotic leakage was observed. All patients could retain urinary function without catheterization. There was no postoperative mortality in all cases.
Conclusion: Standardized laparoscopic TME technique is feasible and safe. It can be ideal approach to rectal cancer.


Session: Poster
Program Number: P129
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