Laparoscopic Anterior Resection with TME for a T4 sigmoid tumor infiltrating the peritoneal refection and the right seminal vesicle using real 3 mm percutaneous surgical instruments with standard 5 mm end-effectors

Luigi Boni, MD, FACS, Luisa Giavarini, MD, Elisa Cassinotti, MD, Giulia David, MD, Sabastiano Spampatti, MD, Stefano Rausei, MD

Minimally Invasive Surgery Center – Univeristy of Insubria

This video shows our technique for laparoscopic anterior resection with TME for a large sigmoid tumor infiltrating the peritoneal reflection and the right seminal vesicle using real 3 mm percutaneous surgical instruments with standard 5 mm end-effectors as retracting devices. Patients was placed in lithotomic position, one 10 mm trocar (for the optic) was placed in the right flank and a further 12 mm in the right iliac fossa. Further two real 3 mm percutaneous surgical instruments were inserted in the sovrapubic midline and left flank respectively: this new instruments can be assembled intracorporally with a standard 5 mm end-effectors in order to achieve a good grip and retraction as for standard 5 mm instruments.

The procedure started with the dissection of the tumor from the peritoneal reflection on the right side that appeared macroscopically infiltrated by the tumor as for local peritoneal seeding.

Isolation of the inferior mesenteric artery and vein was carried out and full mobilization of the left colon completed, the right urether that identify and isolated, and the local infiltration of the peritoneum was removed “en-bloc” requiring partial resection of the seminal vesicle. Total TME was completed and the rectum transected using surgical stapler flowed by end-to-end colo-rectal anastomosis.

Laparoscopic anterior resection can be safely performed even advanced tumor; the used of accessory percutaneous microinstrumens can help to obtain good traction and contra-traction reducing the surgical trauma.

Session: Video Channel Day 1

Program Number: V047