LAPAROSCOPIC ONCOLOGIC ABDOMINOPERINEAL RESECTION

PURPOSE: Although the use of laparoscopic techniques in colorectal sur gery has recently become a focus of major interest in intestinal surge ry, 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 abd ominoperineal resection according to accepted oncologic surgical princ iples can be developed in a cadaver model. The end points of this stud y were intraoperative complications, success in performance of proxima l vascular ligation of the inferior mesenteric artery, complete remova l of the mesorectum including all lymph nodes adjacent to the named re ctal arteries, and wide clearance of pelvic side walls. METHODS: Lapar oscopic 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 o f remaining inferior mesenteric artery, and mesorectal and the pelvic side wall soft tissue were evaluated. RESULTS: 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 w ere found at the base of the inferior mesenteric artery. The median le ngth of remaining inferior mesenteric artery was 5 (range, 1-15) mm. W ide lateral clearance of pelvic side walls was noted in all patients. CONCLUSION: 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 techniq ue.