INTRODUCTION: The rectal irrigation in the laparoscopic operation for rectal cancer is very important to avoid recurrence of the anastomosis, but it is the present conditions not to yet establish certain technique. We devised the safety, simple and unique technique for rectal irrigation in the laparoscopic procedure. We present the new method using the clamp for the open surgery.
METHODS & PROCEDURES: Between February 2005 and September 2008, we have performed 101 colorectal cases in laparoscopic procedure. In the cases, 29 rectal procedures underwent. The ten cases with rectal cancer underwent using the new technique in theses days. The patient was injected ICG to four places in the submucosal membrane near the tumor before the day of the operation. The five trocars were placed including for the flexible scope. After dissection of lymph nodes and ligation of the individual vessels, descending colon and upper rectum were free from the peritoneum using electrocautery and Sonosurg. And the rectal mesentery around the anal side of the tumor was cleared away. The wound of the port at navel was extended for 5 cm and the Alexis was placed there. The rubber glove was attached to Alexis and the Fogarty aorta interception clamp was inserted in the abdominal cavity reversing the part of two fingers. After the injected points of ICG were confirmed, the rectum was clamped using the Fogarty. The distal rectum was irrigated by 500 ml saline and divided using ENDO Cutter that was inserted through another finger of rubber glove. The intestine was pulled out through Alexis. The resection of the sigmoid colon was performed and the anvil was placed within the lumen using pursestring. After the intestine was returned into the abdominal cavity, a 31 mm circular stapler was introduced through the anus. Then the anastomosis was performed between sigmoid colon and rectum. A drain was left in the pelvis.
RESULTS: There were no complications during the operation. The patient tolerated the procedure well and had no complications. The patient was discharged well and is currently doing well.
CONCLUSIONS: The special preparation is not necessary in this method. Although it is necessary that we experience the number of the cases and examine the prognosis of the patients in the long time, this method is very simple, useful and certain to prevent recurrence of the anastomosis for rectal cancer.
Program Number: P122