Laparoscopic Ultralow Rectal Resection with a Modified Transanal Anastomisis - an Alternative of TaTME

Laparoscopic ultralow rectal resection with a modified transanal anastomisis - an alternative of TaTME by Dr. Svilen Maslyankov, University Hospital "Alexandrovska", Medical University – Sofia, e-mail: [email protected], tel.+359887416128.

Laparoscopic approach in operative treatment of rectal tumors apply less surgical trauma, faster recovery of patients and excellent cosmetic result. The oncological guarantee for quality surgery is adequate meso-rectal excision, which has been developed and implemented for the last few years with a transanal approach. The author describes a technique that is considered as a possible TaTME alternative, adequate for the Bulgarian conditions. Applying to this surgery optimizes the results without reducing the quality of the intervention. Clinical case. A 49-year-old woman with a verified middle third (6 cm above dental line) tumour was presented in the clinic. Neoadjuvant 50.4 Gy radiotherapy was completed 7 weeks ago. There is previous history of conventional hysterectomy made one year ago. The intervention was carried out with 3-troacar technique: Tr.1 - 10 mm subumbilical, 30ͦ optics; Tr.2, working - 10 mm and Tr.3 - 5 mm - on the right medioclavicular line. At exploration - no evidence of secondary lesions found. Medial to lateral dissection was carried out with LigaSure, down to the pelvic floor. The full mesorectum excision was performed in the intraabdominal stage. Transrectally through the dilated anus we withdrawed the specimen through a circular incision. Full-thickness one-layer anastomosis was performed manually and the operation ends with the implantation of a loop ileostomy through the right lower trocar orifice. The Duglas cavity was drained through the 5 mm hole. Total operating time was 145 minutes. On the first postoperative day the patient recovered the passage, was fed and moved. She was dehospitalizated at 4 postoperative day. Conclusions: The laparoscopic approach of rectal neoplasms surgical treatment allows less trauma and faster recovery for the patients. The usage of non-standard solutions in this surgery optimizes its application in Bulgaria, without diminishing its quality. The extraction of the tumour transanaly represents an excellent cosmetic result and is one alternative of TaTME surgery, requiring specific technical appliances and learning curve.