Laparoscopic oncologic abdominoperineal resection

Although the use of laparoscopic techniques in colorectal surgery has recently become a focus of major interest in intestinal surgery, there is no proof that an oncologic abdominoperineal resection can be accomplished using laparoscopic techniques. The hypothesis of this study is that a standardized technique for laparoscopic oncologic abdominoperineal resection according to accepted oncologic surgical principles can be developed in a cadaver model. The end points of this study were intraoperative complications, success in performance of proximal vascular ligation of the inferior mesenteric artery, complete removal of the mesorectum including all lymph nodes adjacent to the named rectal arteries, and wide clearance of pelvic side walls.

Laparoscopic abdominoperineal resection was performed in 11 fresh cadavers (1 female and 10 males). After surgery, all cadavers underwent autopsy. The number of removed and remaining mesenteric lymph nodes, length of remaining inferior mesenteric artery, and mesorectal and the pelvic side wall soft tissue were evaluated.

No major intraoperative complications were recorded. The median number of removed lymph nodes in the mesorectum was 12 (range, 6-22) and no remaining lymph nodes were found at the base of the inferior mesenteric artery. The median length of remaining inferior mesenteric artery was 5 (range, 1-15) mm. Wide lateral clearance of pelvic side walls was noted in all patients.

A laparoscopic technique of abdominoperineal resection can be performed according to oncologic principles with proximal vascular ligation of inferior mesenteric artery, wide clearance of pelvic side walls, and complete removal of mesorectum using our described technique.