LAPAROSCOPIC ONCOLOGIC PROCTOSIGMOIDECTOMY WITH LOW COLORECTAL ANASTOMOSIS IN A CADAVER MODEL

The purpose of this study was to demonstrate that a standardized appro ach to laparoscopic proctosigmoidectomy in a cadaver model with (1) in itial proximal ligation of the inferior mesenteric (IM) vascular pedic le, (2) complete mobilization of the splenic flexure, and (3) intraper itoneal stapled colorectal anastomosis can be accomplished in complete accordance with oncologic surgical principles. Using nine cadavers in the fresh state, six abdominal wall cannulas were placed so as to all ow good access to the left colon and rectum. After identifying the lef t ureter and gonadal vessel, the IM pedicle was divided close to the a orta and the left mesocolon was separated from the retroperitoneal str uctures. The sigmoid colon was transected at the proximal resection li ne with an endoscopic stapler, then the splenic flexure and descending colon were completely mobilized. The rectum was freed circumferential ly, dissected first posteriorly, laterally, and anteriorly, and then t ransected in its middle portion with an endoscopic stapler. The specim en was removed through a widened left-lower-quadrant trocar incision a nd the anvil of a circular endoscopic stapler was placed into the prox imal colon extraperitoneally. An intraperitoneal laparoscopic colorect al anastomosis was performed using a double-stapled technique. The med ian length of specimen was 53 cm (range 45-80 cm) and the median numbe r of removed lymph nodes was 15 (range 11-20). A careful abdominal aut opsy was carried out in all cadavers. Length of remaining inferior mes enteric artery was smaller than 1.5 cm in all cases and only one remai ning lymph node (3 mm in diameter) was found adjacent to the IMA in on e subject. No damage to either ureter occurred. All colorectal anastom oses were patent without signs of air leakage or defects on air insuff lation and gross inspection. Using this standardized laparoscopic tech nique, it is possible to perform a proctosigmoidectomy with stapled in traperitoneal anastomosis according to oncologic surgical principles.