Autonomic Nerve-Preserving Total Mesorectal Excision in the Laparoscopic Era |
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Authors: | Suguru Hasegawa Satoshi Nagayama Akinari Nomura Junnichiro Kawamura Yoshiharu Sakai |
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Institution: | (1) Department of Surgery, Kyoto University Hospital, Sakyo, Kyoto, Japan |
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Abstract: | Purpose Although technically demanding, laparoscopy may be advantageous in magnifying the anatomy of the pelvic autonomic nervous
system when performing total mesorectal excision for rectal cancer. We present our method for laparoscopic total mesorectal
excision for men.
Methods We performed laparoscopic total mesorectal excision for 36 men with middle or low rectal cancer. The rectum was mobilized
through a medial approach down to the pelvic floor without minilaparotomy or hand assist. Anteriorly, the dissection plane
was in front of Denonvilliers fascia. Anterolaterally, to preserve the pelvic plexus and neurovascular bundle, Denonvilliers
fascia must be cut at its lateral continuity. We found that the most important factor in obtaining a good surgical view is
keeping adequate tension in the dissection plane by coordination between the surgeon and assistant. Dissection was performed
by using only electrocautery without an ultrasonic dissector or vessel sealing device.
Results No case was converted to open surgery. The short-term feasibility was acceptable.
Conclusions Our method of laparoscopic total mesorectal excision is a feasible approach and may be beneficial for the standardization
and popularization of laparoscopic total mesorectal excision. Long-term results, including survival data and urogenital function,
are needed to evaluate the true efficacy of this procedure.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. |
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Keywords: | Laparoscopy Rectal cancer Surgery |
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