Laparoscopic Ultralow Anterior Resection with Intersphincteric Dissection for Low Rectal Cancer.

Title: Laparoscopic ultralow anterior resection with intersphincteric dissection for low rectal cancer.
Objective: The aim of this video is to show a laparoscopic total mesorectal excision combined with intersphincteric dissection for the treatment of low rectal cancer.
Methods: This is a 58-year-old male with diagnosis of a high grade rectal adenocarcinoma located 4 cm. from the anal verge. After preoperative workup with endoscopic ultrasonography and abdominopelvic CT scan and MRI the tumor was staged as T2N0M0. The operation was performed in Lloyd-Davies position after standard bowel preparation and antibiotic prophylaxis. Four 12 mm. trocars are inserted in the supraumbilical middle line, right lower and right upper quadrant and left lower quadrant. Using a medial to lateral dissection the left colon with the splenic flexure is mobilized. Dissection of the rectum, including circumference of the mesorectum, is performed until the exposition of the levator ani muscle. Thereafter the perineal part of the operation begins. A self-holding retractor is used to expose the anal canal. After submucosal injection of physiological solution, a circumferential incision of the mucosa and internal anal sphincter is performed 1 cm. above the dentate line. The rectum is mobilized proximally on the intersphincteric plane until the level of the laparoscopic pelvic dissection is reached. The rectum and the distal sigmoid colon are pulled through the anal canal and resected. Transanal reconstruction consisted in a hand-sewn end-to-end coloanal anastomosis with a transverse coloplasty. Finally, a diverting loop ileostomy is created.
Results: Postoperative evolution was uneventful and the patient was discharge on the fourth day after surgery. Specimen analysis evidenced a high grade adenocarcinoma T2N0 with free circumferential and longitudinal margins. After the stoma was closed the patient only presented occasional soiling. No recurrence was detected after an 11 month follow-up period.
Conclusion: This video shows the technical feasibility of laparoscopic total mesorectal excision for low rectal cancer combined with the preservation of the sphincter function using the intersphincteric dissection.

Session: Podium Video Presentation

Program Number: V001

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