The Feasible Technique of Mobilizing Intersphincteric Plane Using the Permeated Head Light Through the Anal Procedure in Laparoscopic-Assisted Per Anum Intersphincteric Rectal Dissection

Akiyo Matsumoto, MD, Kaida Arita, MD, Masaki Tashiro, MD, Shigeo Haruki, MD, Shinsuke Usui, MD, Susumu Hiranuma, MD. Department of Surgery, Tsuchiura Kyodo General Hospital

Purpose We report the feasible technique in lower rectal surgery.

Materials and Methods In laparoscopic procedure, after dissecting the Waldeyer and Denonvilliers fasciae, the mesorectum is separated along the plane of the total mesorectal excision. On both sides of the rectum, the lateral ligament with identifying pelvic nerve plexsus is divided by laparoscopic coagulating shears to the level of levator ani muscle. The rectum is mobilized to some degree through the intersphincteric plane between the rectum and the levator ani muscle. Thereafter, the surgeon moves to the perineal side. The anal canal is exposed with a retractor, and the lower margin of tumor is identified under direct vision. The rectum is divided, together with the entire width of the internal anal sphincter 1-2 cm distal to the tumor margin. The rectum is mobilized proximally on the intersphincteric plane. After full mobilization of the circumference of the rectum, the cut edge is closed by hand suturing and irrigated with 1000 ml saline solution. Mobilization of the rectum is continued proximally. When connecting the intersphincteric plane that has already been separated through the abdominal procedure, we use the permeated head light (DLX MicroLux Head Light System; Integra Luxtec, Inc. USA) through the anal procedure. The permeated head light shows adequate dissecting line on the intersphincteric plane through the anal procedure. We can mobilize the intersphincteric plane adequately without dissecting into the rectum, the external anal-sphincter muscle and the levator ani muscle in the narrow view of the intersphincteric space between the internal anal-sphincter muscle and the external anal-sphincter muscle.

Result From January 2011 to the present, this study included 3 patients undergoing laparoscopic per anum intersphincteric rectal dissection for  lower rectal cancer, using the permeated head light through the anal procedure, we can safely dissect the intersphincteric plane through the anal procedure in the narrow view of the intersphincteric space.

Conclusion The technique of mobilizing the intersphincteric plane using the permeated head light from the anal procedure is useful for performing  laparoscopic per anum intersphincteric rectal dissection.

Session Number: Poster – Poster Presentations
Program Number: P033
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