Laparoscopic surgery for early rectal carcinoma

The indications, techniques, and results of laparoscopic surgery for early rectal carcinoma are described in detail. Laparoscopic surgery is indicated when a mucosal tumor is too large to perform endoscopic or transanal resection or the tumor invades the submucosal layer. When the tumor is located in the Rs or Ra region, surgery can be completed laparoscopically. After dissection of the mesenterium and lymphadenectomy are performed, the anal side of the rectum is divided using EndoGIA II. When the tumor is located in the Rb portion, it is impossible to resect the rectum intracorporeally. In this situation, aperi anal maneuver is essential. The rectal mucosa is circumferentially incised just above the dentate line and the internal anal sphincter is dissected. Dissection is advanced to the intersphincteric space. Dissection between the rectum and the levator ani muscle is completed, and the rectum is pulled through the anus. After the oral side of the rectum is divided, a J-pouch is mase and J-pouch-anal anastomosis is performed. Forty-seven patients with rectal carcinoma were operated upon laparoscopically. Postoperative recovery was better than that after open surgery. Serious intraoperative or postoperative complications have not been encountered in this series. In conclusion, laparoscopic surgery is thought to be the procedure of first choice for early rectal carcinoma.