Laparoscopic total mesorectal excision for XXXX .

@entity1 @entity5 @entity190 @entity254 @entity2418 @entity1744
BACKGROUND: Laparoscopic total mesorectal excision for @entity5 is coming out of age with recent publications highlighting its safety, feasibility, sound oncological outcomes, and improved quality of life. Nevertheless, laparoscopic proctectomy remains a challenging procedure. An embedded didactic video demonstrates a step-by-step laparoscopic total mesorectal excision with coloanal @entity254 for a @entity5 . METHODS: A five-trocar technique is shown. The key steps demonstrated are: high division of the inferior mesenteric artery, medial-to-lateral mobilization of the descending colon, high division of the inferior mesenteric vein, take-down of the splenic flexure, total mesorectal excision with division of the rectum at the pelvic floor, and side-to-end coloanal @entity254 . Principles of a good @entity254 and potential pitfalls are described, including protection of the ureter and pelvic autonomic nerves. RESULTS: A series of ten consecutive @entity1 operated for @entity5 with total mesorectal excision is reported. Median (range) operative time and estimated @entity190 were 274 (135-360) minutes and 25 (10-50) ml. Median @entity5 height from the anal verge was 7 (4-10) cm. Reconstruction included three @entity2418 and seven side-to-end @entity254 . Nine anastomoses were performed by using a double-stapled technique. One @entity1 with an intersphincteric dissection required a handsewn @entity254 . A diverting ileostomy protected all coloanal @entity254 . Median length of stay was 3 (range, 2-7) days. One of ten @entity1 was readmitted for a @entity1744 . The embedded video demonstrates a total mesorectal excision down to the pelvic floor in a @entity1 who had a T2 @entity5 6 cm from the anal verge with prior open cholecystectomy and hysterectomy. CONCLUSIONS: Laparoscopic total mesorectal excision is a safe and effective procedure. @entity1 selection and advanced laparoscopic skills are paramount. It is hoped that this didactic video will contribute to a wider and safer practice of laparoscopic total mesorectal excision for @entity5 .
