Improved exposure for excision of rectal carcinomas: initial experiences with a pubic resection technique

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Pelvic Anatomy

Background:

• Rectal cancer surgery presents challenges, especially for tumors located low in the pelvis.
• Exposure of the entire rectum can be difficult with standard surgical approaches.
• Minimizing complications like urinary issues and orthopedic problems is crucial for patient outcomes.

Observation:

• A novel transpubic surgical approach was developed and preliminarily evaluated.
• This technique involves excising a pubic bone wedge and mobilizing the bladder.
• It allows complete exposure of the rectum down to the levator muscles.

Findings:

• The transpubic approach facilitates direct visualization of rectal tumors, even in complex cases.
• It simplifies the performance of low rectal anastomoses (1-2 cm above the anus).
• Potential for reduced urinary problems and no disturbance of sacroiliac joints suggest fewer orthopedic complications.

Implications:

• This approach may offer a viable option for challenging rectal cancer resections.
• It could improve surgical outcomes for low rectal tumors.
• Further research is warranted to validate the long-term safety and efficacy of the transpubic approach.