机器人辅助直肠癌根治术

中间入路,悬吊子宫,自骶岬水平切开乙状结肠系膜及腹膜反折,向左牵拉系膜,显露Toldt’s间隙,解剖肠系膜下血管鞘,离断IMA、IMV,清扫淋巴结。乙状结肠系膜向右牵拉,显露Toldt’s线。在此向头侧游离Toldt’s间隙,避免损伤输尿管和血管。在乙状结肠系膜后方,向尾侧扩展至直肠后间隙,避免损伤腹下神经和骶前静脉丛。暴露直肠系膜与盆壁筋膜之间的无血管间隙并行钝性分离,从后壁中央开始,逐步向两侧进行分离,离断直肠骶骨韧带,分离直肠前壁。对直肠远切端可行肠壁裸化。经肛拖出后离断肿瘤,行腔内吻合。

Robotics assisted radical resection of rectal cancer

The middle approach for surgery was chosen,and the uterus was suspended firstly.The mesentery and peritoneum of the sigmoid colon were incised from the sacral promontory,and the mesentery was pulled to the left,the Toldt’s gap between the colonic mesentery and the posterior abdominal wall was revealed.The mesenteric vascular sheath was found and dissected,The IMA and IMV was ligated and cut,and the lymph nodes were dissected.The sigmoid mesangium was pulled to the right to reveal Toldt’s line.The Toldt’s space was freed cephalically here to avoid damage to the left ureter and reproductive vessels.The loose connective tissue space behind the sigmoid mesangial was extended caudally to the posterior rectal space to avoid injury to the inferior ventral nerve and the anterior sacral venous plexus.The avascular space between the mesentery of the rectum and the fascia of the pelvic wall was exposed and blunt separation was performed.Started from the center of the posterior wall,gradually separate was performed to the sides,the rectum sacrum ligament was detached and finally the anterior wall of the rectum was separated.The intestinal wall could be naked at the distal end of the rectum.After the amputation,the tumor specimen was taken out from the anus.Intracavitary anastomosis was performed.