Laparoscopic Rectal Surgery -how Do We Teach?-

Akiyoshi Kanazawa, MD PhD FACS, Tadayoshi Yamaura, MD, Hisahiro Hosogi, MD PhD, Akio Nakajima, MD PhD, Seiichiro Kanaya, MD PhD FACS, Yukihiro Kohno, MD PhD. Department of 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. On the other hand, we also need to teach the trouble shooting in this procedure. In this presentation, I would like to present how we teach the trainee and what we need to teach the procedure. ?Procedures: 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. There is not objective guideline to be a operator in our department, but when instructor judge it by talking with trainee when the understanding for the procedure is enough, instructor allow trainee to perform the surgery as a operator. Results: Between January 2007 and December 2010, 233 cases laparoscopic resection for rectal cancer was performed in our hospital. laparoscopic low anterior resection: 202 cases, Laparoscopic intersphincteric resection: 15 cases, laparoscopic abdominoperineal resection: 16 cases were performed. Two cases of anastomotic leakage were observed. All patients could retain urinary function without catheterization. There was no postoperative mortality in all cases. Trainee with instruction performed 63% of this procedure. But there is no significant difference in mobility and mortality between trainee operated case and instructor operated case. There is significant difference only in operation time. Conclusion: Laparoscopic rectal surgery still is not standard. For effective education, we should establish the standardized operative view and more simplified technique of laparoscopic rectal surgery.

Session Number: Poster – Poster Presentations
Program Number: P074
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