Laparoscopically assisted resection of the lower rectum

Clinical efficacy of video-assisted gasless transanal endoscopic microsurgery (TEM) for rectal carcinoid tumor

BACKGROUND

We used video-assisted gasless transanal endoscopic microsurgery (TEM) to evaluate 12 consecutive patients for carcinoid tumor with pathologically typical features in the proximal rectum. The study parameters included feasibility, results and final outcome.

METHODS

A scope with an optical angle of 25 and a 7-mm diameter was used for TEM. The carcinoid tumor was resected in full thickness. Primary closure was accomplished using a running suture of 3-0 braided absorbable suture.

RESULTS

The tumor in these patients was <15 mm in diameter. It was localized within the submucosal layer on the oral side from the peritoneal reflection and unreachable via Park's transanal approach. The mean duration of the operation was 63 min. The postoperative course in all patients was free from significant complications, and all patients were discharged within 1 week. None of the patients had postoperative pain or required sedatives.

CONCLUSION

Video-assisted gasless TEM is a simple and minimally invasive procedure to treat benign carcinoid tumors in the proximal rectum.

Laparoscopic lower anterior resection is equivalent to laparotomy for lower rectal cancer at the distal line of resection

BACKGROUND

Procedures that involve resection of the distal rectum challenge the current limitations of laparoscopic technology, because of lack of compact articulating stapling instruments.

METHOD

We improve the procedure with the aid of a Lap disk, an abdominal wall sealing device that was developed for hand-assisted manipulation. A linear stapler capable of changing its stop angle is inserted through the disk, and the rectum is transected by the disk during a second pneumoperitoneum.

RESULTS

The transection line becomes equivalent to that obtained with laparotomy.

CONCLUSION

This new technique made laparoscopic lower anterior resection possible to transect the lower rectum in the same way as is done with laparotomy.