Laparoscopic total mesorectal excision with autonomic nerve preservation

Abstract

Laparoscopy has greatly influenced abdominal surgery. We hypothesize that the benefits of minimally invasive surgery are applicable to rectal cancer. A cadaver model of laparoscopic rectal resection with total mesorectal excision (TME) and autonomic nerve preservation was utilized to explore this hypothesis. The principles of TME were followed, including high vascular ligation, sharp mesorectal dissection, and identification and preservation of the autonomic pelvic nerves. After proving feasibility in the cadaver model, a clinical study was performed on patients with mid to low rectal cancers. We observed acceptable morbidity with this minimally invasive technique of rectal resection and TME. We conclude that there is growing evidence that laparoscopic methods can be applied to patients with rectal cancer.

Laparoscopic intersphincteric resection with coloplasty and coloanal anastomosis for mid and low rectal cancer

“…Indeed, laparoscopic low anterior resection is difficult to perform, especially in men, which is why some authors choose to perform a low transverse or midline abdominal incision to facilitate rectal division with a linear stapler in the manner of a conventional open approach 10,11 . The authors consider total mesorectal excision with coloanal anastomosis to be the optimal treatment for mid and low rectal cancer.…”

Long-term results of laparoscopic versus open resections for rectal cancer for 124 unselected patients

“…This relevant aspect probably is related to the magnified view and to the better vision obtained by the angled optics, together with the reduced manipulation of the mesorectum during the laparoscopic pelvic dissection [16]. In addition, magnification of the image facilitates a correct nerve-sparing technique [27].…”

Laparoscopic Assisted Distal Rectal Cancer Resection with Preoperative Concurrent Chemoradiotherapy

“…It was easier to identify the Denonvillier's fascia, the pelvic nerve and the pelvic floor with performing laparoscopy than when performing conventional surgery. Laparoscopic total mesorectal excision with autonomic nerve preservation was reported to be feasible after analysis of cadaver models (1).…”