Usefulness of Needle-guided Laparoscopic Abdominoperineal Resection for Low Rectal Cancer

Takehito Yamamoto, Akiyoshi Kanazawa, Ryo Ohno, Hiroyuki Matsubara, Toru Goto, Takuya Okamoto, Yoichiro Uchida, Shugo Ueda, Akira Mori, Hiroaki Terajima. Kitano Hospital,The Tazuke Kofukai Medical Research Institute

INTRODUCTION: During laparoscopic abdominoperineal resection (APR) for low rectal cancer, prevention of circumferential resection margin (CRM) involvement is important. Laparoscopic APR is superior to open APR because it allows for direct and precise visualization of the deep intrapelvic space. However, the local recurrence and survival rates after APR are reportedly not lower than those associated with anterior resection. One reason for this is the difficulty in properly resecting the levator muscles to prevent CRM involvement. We implemented a method that allows for resection of the levator muscles without closely approaching the rectal wall and that creates a cylindrical specimen.

METHODS AND PROCEDURES: The mesorectum is dissected caudally to the level of the levator muscle, and the ureter and pelvic autonomic nerves are carefully protected during dissection. The surgeon inserts the needle through the perineum from the dorsal side of the anus to the internal aspect of the tip of the sacrum. The levator muscles and fat tissue are resected laparoscopically following the needle, which emerges from the levator muscles. The specimen is resected from the perineum following the needle, and the intra-abdominal space is easily reached.

RESULTS: Laparoscopic needle-guided resection of the levator muscles is safe and superior to the conventional procedure because it avoids the surgical waist caused by conventional APR and easily prevents CRM involvement.

CONCLUSION: Needle-guided laparoscopic APR can be easily and safely performed to reduce CRM involvement. This technique contributes to the standardization of laparoscopic APR.

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