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Techniques in Coloproctology

, Volume 22, Issue 8, pp 613–615 | Cite as

Tips and tricks for rectal dissection during laparoscopic ultra-low anterior resection

  • C. Warren
  • A. E. R. Hamilton
  • D. G. Taylor
  • A. R. L. Stevenson
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Introduction

The introduction of total mesorectal excision (TME) for rectal cancer was popularised and promoted by Heald from 1979 onwards. He described dissection in the “holy plane” maintaining the integrity of the mesorectal fascial envelope. Since then, there has been a dramatic fall in the rate of local recurrence and an increase in 5-year survival following surgery for rectal cancer [1, 2].

Laparoscopic ultra-low anterior resection (LULAR) for rectal cancer currently remains controversial. Although long term follow-up results are pending, several major trials have failed to show short-term non-inferiority when compared to open resection [3, 4]. LULAR is, however, widely practiced and this is likely to continue into the future, especially due to the ongoing drive towards minimally invasive surgery and the recent ROLARR trial failing to confer a significant benefit of robotic TME over laparoscopic TME [5].

We describe our technique for LULAR in detail and provide a video...

Keywords

Laparoscopic surgery Rectal cancer Total mesorectal excision (TME) Anterior resection Ultra-low 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any research on human participants or animals performed by any of the authors. It describes modification of a technique of an established surgical procedure.

Informed consent

Informed consent was obtained from all participants.

Supplementary material

Figure 3: Video of laparoscopic ultra-low anterior resection. (MP4 280451 KB)

References

  1. 1.
    Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Br J Surg 69(10):613–616CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1(8496):1479–1482CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Stevenson AR, Solomon MJ, Lumley JW et al. (2015) Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA 314(13):1356–1363.  https://doi.org/10.1001/jama.2015.12009 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Fleshman J, Branda M, Sargent DJ et al. (2015) Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA 314(13):1346–1355.  https://doi.org/10.1001/jama.2015.10529 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Jayne D, Pigazzi A, Marshall H et al (2017) Effect of robotic-assisted vs conventional laparoscopic surgery on risk of conversion to open laparotomy among patients undergoing resection for rectal cancer: the ROLARR randomized clinical trial. JAMA 318(16):1569–1580CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of Colorectal SurgeryThe Royal Brisbane and Women’s HospitalHerstonAustralia
  2. 2.Colorectal UnitThe Wesley HospitalAuchenflowerAustralia
  3. 3.Faculty of MedicineThe University of QueenslandHerstonAustralia
  4. 4.The Holy Spirit Northside Private Hospital BrisbaneChermsideAustralia

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