[Laparoscopic abdomino-perineal rectum excision]

In the department of surgery at the Medical University of Luebeck 10 laparoscopic abdomino-perineal rectum resections were performed within 2 years. Using 3-4 working trocars the intraabdominal dissection of the rectum and sigmoid colon, complete lymphadenectomy with radicular dissection of the inferior mesenteric artery and vein, and dissection of the mesocolon and colon were accomplished. Following a conventional perineal excision the specimen was delivered through the perineal wound. The procedure is finished by establishing a conventional colostomy using the upper left trocar incision. The operation times ranged from 4 to 7.5 hours. The patients--51 to 82 years old--left hospital within 2 weeks after operation. 18 months after operation all patients operated with curative intention were still alive and tumor free except one patient, who died after a heart attack without any recurrent tumor. Two smaller, local stoma complications and one venous bleeding occurred postoperatively. There was no conversion to open surgery caused by intraoperative complications. The abdomino-perineal resection seems to be an ideal indication for laparoscopic surgery, because of its completely intraabdominal preparation, the excellent laparoscopic view into the small pelvis, the oncologic lymphadenectomy and the unproblematic delivery of the specimen.