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Case Reports
. 2018 Aug;6(16):324.
doi: 10.21037/atm.2018.08.02.

Laparoscopic sphincter-saving surgery for low rectal cancer through marker meeting approach

Xuefei Yang  1 , Guixi Zhang  1 , Li Jiang  1 , Hao Zhang  1 , Zhihai Liu  1 , Jingsi Liu  1 , Yang Deng  1 , Kai Pan  2 , Joe King Man Fan  1   3
Affiliations
Case Reports

Laparoscopic sphincter-saving surgery for low rectal cancer through marker meeting approach

Xuefei Yang et al. Ann Transl Med. 2018 Aug.

Abstract

Laparoscopic low anterior resection (LAR) with sphincter preservation for ultra-low rectal cancer is always a challenging operation in colorectal surgery. To achieve negative margins, reducing the difficulty and risks of the procedure are major goals for us. The marker meeting approach we reported can help to accomplish this goal. The key technique for the marker meeting approach is to ensure a clear distal margin in a low resection of the rectum by transanal dissection. This procedure allows access to the space around the distal rectum and mesorectum and to pack the gauzes in the distal part of the space as a landmark. Routine laparoscopic LAR was performed to dissect the space until reaching the gauzes packed above and achieve complete mobilization of the rectum and mesorectum. This surgical procedure is simpler and reduces the difficulty of the operation. Therefore, it is expected to reduce the risk of surgery-related complications and positive margins and is suitable to be widely applied and extended in clinical practice. The short-term and long-term clinical outcomes of the marker meeting approach need more research in large samples.

Keywords: Low rectal cancer; laparoscopic low anterior resection (laparoscopic LAR); marker meeting; total mesorectal excision (TME).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Purse-string suture below the tumor through anus (animated drawing: Dr. Jingsi Liu).
Figure 2
Figure 2
Transanal full-thickness rectal resection with ultrasonic dissector (animated drawing: Dr. Jingsi Liu).
Figure 3
Figure 3
Gauze packing into anus (animated drawing: Dr. Jingsi Liu).
Figure 4
Figure 4
Gauze packing into the space surrounding the rectum and push the rectal stump to the pelvis slightly (animated drawing: Dr. Jingsi Liu).
Figure 5
Figure 5
Trocar placement.
Figure 6
Figure 6
Meeting the gauzes.
Figure 7
Figure 7
Completely free the purse-string-sutured rectal stump along the surface of the gauzes.
Figure 8
Figure 8
The preserved suture tail in place indicated the reliability of the purse-string suture.
Figure 9
Figure 9
Manually coloanal anastomosis under direct vision.
Figure 10
Figure 10
Gross examination of the distal margin of the specimen was approximately 1.5 cm to the tumor.
See this image and copyright information in PMC

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