Laparoscopic Law Anterior Resection for Rectal Cancer without Small Incision

Koya Hida, MD, Daiki Yasukawa, MD, Atuhiko Sumii, MD, Shintaro Okumura, MD, Masato Matuura, MD, Naoki Uyama, MD, Atsushi Itami, MD, Takahisa Kyogoku, MD

Division of Gastrointestinal Surgery, Nishi-Kobe Medical Center

Introduction: Laparoscopic surgery for colorectal cancer has spread all over the world during the last two decades. Less invasive approaches are required in these days.
[Methods] We introduce a new method " Laparoscopic low anterior resection without small incision by using flexible plastic tube and wound retractor".

Case: Laparoscopic TME was proceeded with 5 ports in the usual way.After regional lymph node dissection, flexible plastic tube was inserted from anus through the colon proximal to the tumor. Rectum and the tube were transected together on the level of 10cm proximal to the tumor by linear stapler. Then the distal rectum was easily reversed from anus by pulling the plastic tube. The reversed rectum was cut at the distant area and the dissected lymph nodes were drawn out, then a wound retractor was placed through the reversed rectum. The proximal intestine was pulled down through the retractor, and the anvil head was put into the stump. After putting back the proximal intestine to abdominal cavity and removing the retractor, rectal lavage was performed to wash out the cancer cells. Then the rectum was dissected with an adequate margin under direct vision by linear stapler. Finally, double stapled anastomosis was performed by using circular stapler. His postoperative course was uneventful.

Conclusion: Laparoscopic low anterior resection without small incision for rectal cancer by using flexible plastic tube and wound retractor is a reasonable option especially for early lower rectal cancer.

Session: Poster Presentation

Program Number: P129

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