Experience with laparoscopic medial and lateral dissection of the rectosigmoid for cancer

The anatomical significance and techniques of laparoscopic rectal surgery

BACKGROUND

Because there are difficulties associated with the technique of laparoscopic colorectal surgery, thorough knowledge of the anatomy is particularly important. We pay close attention to anatomical features during laparoscopic rectal surgery. In this study, we analyze the association of the anatomy with the operative procedure.

METHODS

Laparoscopic rectal surgery was performed on 117 patients (66 men) with benign and malignant diseases in the rectum by the complete laparoscopy or hand-assisted technique. All operations were mainly performed by the first author. The association between anatomy and the operation was analyzed.

RESULTS

The mean operative time was 144 min (range, 87-235). The hand-assisted technique was performed in two patients. Four patients required conversion to laparotomy due to the amount of fat in three patients and disruption of the Endo-stapler in one patient, for a conversion rate of 1.7%. Operative blood loss was small, averaging 126 ml (range, 50-350). No injury of the ureters, major bleeding in front of the sacrum, or other operation-related severe complications occurred during or after operation. In one case, dissecting disrupted the anterior left wall of the rectum.

CONCLUSION

By mastering the anatomical features of laparoscopic rectum surgery, operative mistakes and complications can be reduced. Particular attention must be paid to the anatomy of the obese patient undergoing laparoscopy. It is very convenient that the corresponding skills can be applied in the course of dissection and exposure.