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Laparoscopic Technique for Low Anterior Resection

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Abstract

Total mesorectal excision (TME) is the standard surgical treatment for rectal cancer. Studies suggest that compared with open resection, laparoscopic TME provides similar oncologic outcomes while reducing hospital stay, minimizing recovery time, and improving cosmesis. The smaller abdominal incisions may also decrease the risk of wound infections and incisional hernia formation. In fact, the laparoscopic technique facilitates the surgical process by allowing for increased maneuverability and enhanced visualization within the surgical field of the pelvis. In this chapter, we focus on the major elements of laparoscopic low anterior resection and TME, highlighting the capability of achieving a laparoscopic approach to produce a favorable oncologic outcome.

Keywords

  • Rectal cancer
  • Total mesorectal excision
  • Laparoscopic
  • Low anterior resection

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Correspondence to Antonio M. Lacy M.D., Ph.D. .

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In this video, the surgeon demonstrates his approach to laparoscopic low anterior resection. (MP4 1507506 kb)

Key Operative Steps

Key Operative Steps

  1. 1.

    The abdominal cavity is accessed and the small bowel and omentum are moved toward the right upper quadrant.

  2. 2.

    The inferior mesenteric artery is divided near its origin after identifying the left ureter.

  3. 3.

    The descending colon and sigmoid colon are mobilized using a medial-to-lateral approach.

  4. 4.

    The inferior mesenteric vein is divided.

  5. 5.

    The splenic flexure is mobilized.

  6. 6.

    Start total mesorectal excision with dissection into the presacral plane.

  7. 7.

    Dissect the peritoneal attachments on the right and left sides of the rectum and on the anterior peritoneal reflection.

  8. 8.

    For middle and proximal rectal tumors, exteriorize the specimen with a Pfannenstiel incision, resect the proximal colon, and introduce the anvil of the circular stapler. For ultralow tumors, the specimen is exteriorized transanally, the proximal rectum is transected, and a hand-sewn anastomosis is performed.

  9. 9.

    Close ports that are 10–12 mm in size.

  10. 10.

    Create diverting ileostomy.

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Toscano, M.J., Lacy, A.M. (2015). Laparoscopic Technique for Low Anterior Resection. In: Kim, J., Garcia-Aguilar, J. (eds) Surgery for Cancers of the Gastrointestinal Tract. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1893-5_21

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  • DOI: https://doi.org/10.1007/978-1-4939-1893-5_21

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1892-8

  • Online ISBN: 978-1-4939-1893-5

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