Laparoscopic total mesorectal excision for rectal cancer
- Resource Type
- Authors
- Manfred Odermatt; Nuno Figueiredo; Amjad Parvaiz
- Source
- Laparoscopic Colorectal Surgery ISBN: 9781315175751
- Subject
- medicine.medical_specialty
medicine.diagnostic_test
Colorectal cancer
business.industry
medicine.medical_treatment
Sigmoidoscopy
Anastomosis
medicine.disease
Total mesorectal excision
Surgery
Abdominal wall
Ileostomy
medicine.anatomical_structure
medicine
Sphincter
business
Pelvis
- Language
The Medical Research Council Conventional versus Laparoscopic-Assisted Surgery in Colorectal Cancer trial was the first large study to also include rectal cancer patients. Supervised training has been shown to shorten the proficiency gain curve in all levels of surgical proficiency, without compromising patient safety. Magnetic resonance imaging of the pelvis is routinely performed to assess the relationship of the tumour to the mesorectal fascia and the sphincter. The bowel end with the anvil is brought into the pelvis to reassure that a tension-free anastomosis is possible. A flexible sigmoidoscopy is performed to assess the integrity of the anastomosis. The pelvis is irrigated, and leaks are excluded by insufflating the colon with air. A mobile ileal loop in proximity to the caecum is brought up to the abdominal wall for creation of an ileostomy in a standard fashion. Laparoscopic rectal resection remains a challenging and technically demanding procedure.