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Surgical Techniques in Rectal Cancer pp 257–268Cite as

Reduced Port Laparoscopic TME with Coloanal Anastomosis

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Abstract

We began performing a single-incision plus one additional port laparoscopy-assisted anterior resection of the rectum (SILS+1-AR) in August 2010. In recent years, intersphincteric resection (ISR) is proposed as a means of offering sphincter preservation in patients with very low rectal cancer and has become an accepted surgical procedure. Moreover, the procedure of ultralow anterior resection mainly includes an ISR for sphincter-saving operation. Therefore, we applied SILS+1 partial ISR in cases of rectal cancer located within 5 cm from the anal verge.

In the SILS+1-AR without ISR, a 3-cm trans-umbilical incision was made, and the SILS™ port was inserted, and an additional 12-mm trocar was placed in the right lower quadrant. In the SILS+1 partial ISR, a SILS™ port was placed in the right lower quadrant at the intended ileostomy site, and a 5-mm trocar was inserted at the umbilicus at the subsequent drain site. The surgical procedure of partial ISR included five stages: colonic mobilization, pelvic dissection with total mesorectal excision (TME), transabdominal dissection of the intersphincteric space, stapled coloanal anastomosis, and diverting stoma. All postoperative outcomes were satisfactory (data not shown).

Reduced port laparoscopic TME for rectal carcinoma with or without ISR can be performed safely, and its feasibility depends on proper selection of patients.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo, 060-8638, Japan

    Shigenori Homma, Futoshi Kawamata, Susumu Shibasaki, Takahisa Ishikawa, Tadashi Yoshida, Hideki Kawamura, Norihiko Takahashi & Akinobu Taketomi

Authors
  1. Shigenori Homma
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  2. Futoshi Kawamata
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  3. Susumu Shibasaki
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  4. Takahisa Ishikawa
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  5. Tadashi Yoshida
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  6. Hideki Kawamura
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  7. Norihiko Takahashi
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  8. Akinobu Taketomi
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Corresponding author

Correspondence to Shigenori Homma .

Editor information

Editors and Affiliations

  1. Saint-Pierre University Hospital, Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Brussels, Belgium

    Giovanni Dapri

  2. Minimally Invasive Colorectal Surgery, Lankenau Medical Center, Main Line Healthcare, Wynnewood, Pennsylvania, USA

    John H Marks

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Homma, S. et al. (2018). Reduced Port Laparoscopic TME with Coloanal Anastomosis. In: Dapri, G., Marks, J. (eds) Surgical Techniques in Rectal Cancer. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55579-7_16

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  • DOI: https://doi.org/10.1007/978-4-431-55579-7_16

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  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-55578-0

  • Online ISBN: 978-4-431-55579-7

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