A New Laparoscopic Surgical Procedure to Achieve Sufficient Mesorectal Excision in Upper Rectal Cancer

Ohigashi, Seiji; Takenaka, Takashi; Sudo, Kazuki; Shiozaki, Hironori; Onodera, Hisashi

doi:10.1155/2011/708439

Cited by 3 publications

(6 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The difficulty of the TSME operation is the management of the mesorectum. Seiji [21] has reported on the management of the mesorectum in the narrow pelvis, which our treatment method is based on. First, the right part of the mesorectum is lifted from the right side of the sigmoid mesocolon to expose the inferior mesenteric artery and vein, left colonic vessels, sigmoid colonic vessels, and superior rectum vessels.…”

Section: Discussionmentioning

confidence: 99%

The feasibility of laparoscopic TSME preserving the left colic artery and superior rectal artery for upper rectal cancer

Zhang

Wei

et al. 2020

World J Surg Onc

View full text Add to dashboard Cite

Background: Laparoscopic tumor-specific mesorectal excision (TSME) preserving the left colic artery and superior rectal artery is still a technically challenging procedure. We conducted this study to demonstrate the feasibility of this procedure for upper rectal cancer. Methods: A total of 184 patients with upper rectal cancer were retrospectively analyzed in our cancer center between April 2010 and April 2017. These patients were treated with either laparoscopic TSME (n = 46) or laparoscopic total mesorectal excision (TME) (n = 138). In the TSME group, the left colonic artery and superior rectal artery were preserved while they were not in the TME group. Results: The operation time in the TSME group was longer than that in the TME group (218.56 ± 35.85 min vs. 201.13 ± 42.65 min, P = 0.004). Furthermore, the number of resected lymph nodes in the TSME group was greater than that in the TME group (19.43 ± 9.46 vs. 18.03 ± 7.43, P = 0.024). The blood loss between the TSME and TME groups was not significant. No mortality occurred in either the TSME or TME groups. One patient in the TME group underwent conversion to laparotomy. The total postoperative complication rates in the TSME and TME groups were 8.7% and 17.4%, respectively. There was no difference in severe complications between the two groups (anastomotic leakage and stenosis). Conclusions: Laparoscopic TSME preserving the left colic artery and superior rectal artery can be safely conducted for upper rectal cancer.

show abstract

Section: Discussionmentioning

confidence: 99%

The feasibility of laparoscopic TSME preserving the left colic artery and superior rectal artery for upper rectal cancer

Zhang

Wei

et al. 2020

World J Surg Onc

View full text Add to dashboard Cite

show abstract

“…The present study presented and evaluated a novel for mesorectal division method in RALS TSME. Although for mesorectal division in TSME is difficult, only a small number of reports have described methods of mesorectal division, even in open and laparoscopic surgery [3,8], and to our knowledge, no reports have evaluated this procedure in RALS. Ours is the first report evaluating a useful mesorectal division method during RALS TSME, which we named SST.…”

Section: Discussionmentioning

confidence: 99%

“…Surgeons have several choices when dividing the mesorectum during RALS, namely, whether the console surgeon or the patient-side surgeon divides the mesorectum and with what devices. Regarding the devices used during mesorectal division, staplers; advanced bipolar clamps, such as the LigaSure™ (Medtronic, Minneapolis, MN); and a Harmonic Scalpel are all options to avoid bleeding [3,6,8]. In this study, we evaluated the usefulness of SST compared with two other methods (non-SST): division using the EndoWrist ® Vessel Sealer instrument by the console surgeon and division using a Harmonic Scalpel by the patientside surgeon.…”

Section: Discussionmentioning

confidence: 99%

“…Whether surgery is performed laparoscopically or with a conventional open method, TSME is sometimes performed obliquely to the anal side, introducing unnecessary rectal resection, which may lead to postoperative bowel malfunction [7]. Particularly in laparoscopic surgery, performing straight and sharp division of the mesorectum is difficult, and the division line is likely to be in a zigzag/irregular pattern because of difficulty recognizing stereoscopic depth [8]. In addition, during laparoscopic surgery, difficulty exposing the division line of the distal rectum could be a reason for conversion [9].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Surgical technique for mesorectal division during robot-assisted laparoscopic tumor-specific mesorectal excision (TSME) for rectal cancer using da Vinci Si surgical system: the simple switching technique (SST)

et al. 2020

View full text Add to dashboard Cite

In a narrow pelvic cavity, performing sufficient tumor-specific mesorectal excision (TSME) is difficult. Even in robotassisted laparoscopic surgery (RALS), mesorectal division is difficult in a narrow pelvic cavity. To overcome this difficulty, we invented a novel method of mesorectal division. In this new approach, we switched the fenestrated bipolar forceps and the double-fenestrated forceps with each other so that both instruments were placed on the same (right) side of the patient. After the mesorectal fat and vessels were coagulated using the fenestrated bipolar forceps, coagulated tissues were divided using the monopolar scissors in the same direction. We named this technique the "simple switching technique (SST)". We retrospectively collected data and evaluated the usefulness of SST in 24 consecutive patients who underwent RALS TSME between July 2018 and January 2020. Twelve patients underwent SST, and 12 patients underwent other conventional surgical methods (non-SST). The median operation time for mesorectal division was 809.5 s (range 395-1491 s) in the SST group and 985.5 s (range 493-2353 s) in the non-SST group. The coefficient of variation for non-SST was 0.545, which was > 1.5 times the coefficient of 0.360 for SST. Although no significant differences were found for operation time for mesorectal division, the operation time for mesorectal division by SST tended to be shorter than by non-SST (P = 0.157). No significant differences were found regarding short-term outcomes between the groups. SST is feasible and can be an optional method of mesorectal division in RALS TSME.

show abstract

“…The di culty of the TSME operation is the management of the mesorectum. Seiji [21] has reported on the management of the mesorectum in the narrow pelvis, which our treatment method is based on. First, the right part of the mesorectum is lifted from the right side of the sigmoid mesocolon to expose the inferior mesenteric artery and vein, left colonic vessels, sigmoid colonic vessels, and superior rectum vessels.…”

Section: Discussionmentioning

confidence: 99%

The Feasibility of Laparoscopic TSME Preserving the Left Colic Artery and Superior Rectal Artery for Upper Rectal Cancer

Zhang

Wei

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Laparoscopic TSME preserving the left colic artery and superior rectal artery is still a technically challenging procedure. We conducted this study to demonstrate the feasibility of this procedure for upper rectal cancer. Methods A total of 184 patients with upper rectal cancer were retrospectively analyzed in our cancer center between April 2010 and April 2017. These patients were treated with either laparoscopic TSME (n=46) or laparoscopic TME (n=138). In the TSME group, the left colonic artery and superior rectal artery were preserved while they were not in the TME group. Results The operation time in the TSME group was longer than that in the TME group (218.56 ± 35.85 min vs. 201.13 ± 42.65 min, P=0.004). Furthermore, the number of resected lymph nodes in the TSME group was greater than that in the TME group (19.43 ± 9.46 vs. 18.03 ± 7.43, P=0.024). The blood loss between the TSME and TME groups was not significant. No mortality occurred in either the TSME or TME groups. One patient in the TME group underwent conversion to laparotomy. The total postoperative complication rates in the TSME and TME groups were 8.7% and 17.4%, respectively. There was no difference in severe complications between the two groups (anastomotic leakage and stenosis).Conclusions Laparoscopic TSME preserving the left colic artery and superior rectal artery can be safely conducted for upper rectal cancer. [1]

show abstract

A New Laparoscopic Surgical Procedure to Achieve Sufficient Mesorectal Excision in Upper Rectal Cancer

Cited by 3 publications

References 14 publications

The feasibility of laparoscopic TSME preserving the left colic artery and superior rectal artery for upper rectal cancer

The feasibility of laparoscopic TSME preserving the left colic artery and superior rectal artery for upper rectal cancer

Surgical technique for mesorectal division during robot-assisted laparoscopic tumor-specific mesorectal excision (TSME) for rectal cancer using da Vinci Si surgical system: the simple switching technique (SST)

The Feasibility of Laparoscopic TSME Preserving the Left Colic Artery and Superior Rectal Artery for Upper Rectal Cancer

Contact Info

Product

Resources

About