Laparoscopic Sphincter-Preserving Surgery for Low Rectal Cancer Using Intersphincteric Resection Technique and a Bulldog Clamp

Bo Feng, MD, Minhua Zheng, MD. Department of Surgery, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai Minimally Invasive Surgery Center, Shanghai 200025, China

Objective To assess the feasibility and outcome of laparoscopic sphincter-preserving surgery for low rectal cancer using intersphincteric resection technique and a bulldog clamp. Methods We applyed a new technique combination of laparoscopic sphincter-preserving surgery for very low rectal cancer, which includes intersphincteric resection(ISR) technique, transanal hand-sewn anastomosis and a bulldog clamp. The technique tips, status of recovery, complications, oncological clearance and results of short-term follow-up were studied in 15 cases. Results None of the cases was converted to open surgery. The mean operation time was 185(150–232) min, and the mean blood loss was 75 (25–105)ml. The mean time for passage of flatus,duration of urinary drainage, and postoperative hospital stay were 3 (1-4) d,6(5-10) d and 11 (7-20) days respectively. The total amount of lymph nodes harvest was 15 (9-21), and the mean distal margin from the tumor was 2.5 (1.0-3.9) cm. No major complication was observed. The mean follow-up time was 13 (4-27) mons. No local recurrence or metastasis was observed. Acceptable anal function results were obtained in most patients. Conclusion laparoscopic sphincter-preserving surgery for low rectal cancer using intersphincteric resection technique is feasible and safe. It can be an option for sphincter saving surgery. However, more researches should be done for long-term outcomes.