[Anterior resection of the rectum via laparoscopy]

Of the newer laparoscopic procedures for colorectal cancers the abdominoperineal resection of the rectum was previously communicated in this journal. The laparoscopic anterior resection is a more technically demanding operation. We report the case of 63 years old women with a rectal cancer at 9 cm from the anus. The procedure was realised under general anaesthesia, with a urinary catheter in place. An blunt obturator was introduced into the uterine cavity and used to manipulate the uterus during the procedure. After establishing of the pneumoperitoneum, a 30 degrees telescope was introduced through the umbilical port (10 mm). The 30 degrees telescope allows visualization of the splenic flexure and rectal side wall. The main steps of the procedure were the exploration of the abdominal cavity, mobilization of the descendent colon and sigmoid, exposure of the left ureter, division of the left sided peritoneal leaf and division of the inferior mesenteric vessels. The anterior dissection of the rectum was facilitated by manipulation of the uterus. The rectum was then mobilized with the "abdominalization of the tumor". A 5 cm left paramedian vertical incision was performed; through this incision a stapler was introduced and the rectum was transected 5 cm under the tumor. The rectum with the tumor, the sigmoid and mesosigmoid were exteriorized through the incision; the sigmoid was divided with a linear stapler cutter 20 cm above the tumor and the specimen was removed extracorporeally. The anvil of a circular stapler was secured in the left colon and returned in the abdominal cavity. The body of the stapler was inserted into the rectal stump through the anus and connected intracorporeally to the anvil. The postoperative evolution was simple; flatus and feces were passed at 48 hours. The patient was discharged to home after 6 days, 13 months after operation she has no morbidity.