Ressecção anterior ultrabaixa e interesfinctérica do reto com anastomose coloanal por videolaparoscopia

Abstract

The author present the laparoscopic coloanal anastomosis and intersphincteric resection technique to treat patients with very low rectal cancer. The operative steps are: 1 - Patient positioning; 2 - Instruments and equip positioning; 3 - Insertion of the ports; 4 - Preparation of the operative field; 5 - Difining and dividing the inferior mesenteric artery and vein by the medial approach; 6 - Mobilization of splenic flexure and sigmoid colon; 7 - rectal mobilization and total mesorectum excision by Rullier technique; 8 - Rectal division and coloanal anastomosis; 9 - intersphincteric resection and coloanal anastomosis by coloplasty, J pouch or latero-to-end techniques. The technique employed is safe and have presented low rate of complication and no mortality.

Four-arm single docking full robotic surgery for low rectal cancer: technique standardization

“…The rectosigmoidectomy with a total mesorectal excision is performed in order to resect the visceral structures of the pelvis (rectum and mesorectum) covered by the visceral fascia and preserve the somatic structures (autonomic sympathetic and parasympathetic nerve plexuses), covered by the pelvic fascia. The total mesorectal excision and mobilization of the rectum are made according to the following systematization: 1-rectal dissection in the horizontal or sacral plane 15,16 -the upper rectum is posteriorly dissected by section with scissors with monopolar cautery (arm 1) through the avascular presacral plane between the visceral and parietal fascia, with the promontorium as anatomical reference. The upper and right anterior traction of the rectosigmoid by the long grasper placed in the third robotic arm facilitates the exposure; this grasper remains motionless until further change of position.…”

Avaliação de qualidade de vida dos pacientes submetidos à cirurgia de amputação abdominoperineal do reto com colostomia abdominal ou colostomia perineal

“…Entretanto, houve diferença estatística relacionada à presença de prolapso e, esta complicação está associada à liberação cirúrgica da flexura esplênica para deixar o cólon livre e promover o seu abaixamento no períneo, tendo sido, esta estrutura, apenas mobilizada nos pacientes com CA (Ramos, 2009). Este resultado é relevante para que seja reavaliada a técnica nos pacientes candidatos à CP.…”