INTRODUCTION: This video demonstrates a step-by-step approach to laparoscopic total mesorectal excision and coloanal anastomosis. Emphasis is placed on the features that respect the same oncologic principles as open surgery.
PROCEDURE
This case features a 38 year old man with a carpeting tubulovillous adenoma of the rectum extending from the dentate line to 20 cm from the anal verge. The procedure commences with lateral-to-medial mobilization of the sigmoid and descending colon, taking care to identify the left ureter. The splenic flexure is mobilized with a combination of lateral dissection off the retroperitoneum and medial division of the lesser sac alongside the distal transverse colon. In the pelvis, the left pararectal peritoneum is scored to enter the presacral space. A total mesorectal dissection is performed down to the level of the pelvic floor, identifying and protecting the hypogastric nerves. Transection of the rectum is performed at the level of the pelvic floor, incorporating the entire polyp within the specimen. The inferior mesenteric artery is transected at its base, and the specimen is exteriorized via a 4cm periumbilical incision. After placing an EEA anvil extracorporeally, the pneumoperitoneum is re-established and the anastomosis is created under laparoscopic visualization, and an ileostomy is created. Pathologic examination confirmed an intact TME specimen and resection of the entire carpeting polyp.
Session: Podium Video Presentation
Program Number: V003
« Return to SAGES 2009 abstract archive
