Video summary: Low anterior resection

March 25, 2008 § 3 Comments

Low anterior resection

Some videos I’ve made of surgery for colorectal cancer was published this week on www.oncolex.org.

These videos are the first made with a new camera stand I’ve designed. It provides excellent access to open abdominal surgery.

This post features a low anterior resection. The next will feature a left hemicolectomy, a cylindrical abdomino-perineal resection (APR) and a peritonectomy with hyperthermic intraperitoneal chemotherapy (HIPEC).

Watch the low anterior resection video

Low anterior resection

  • Pre-chemoradiation MRI shows a tumor in the center part of the rectum, infiltrating the vaginal top. The resection will include a part of the distal sigmoid colon, the rectum, vaginal top and uterus with ovaries and fallopian tubes.
  • Post-chemoradiation MRI shows significant tumor regression.
  • View from the foot end of the operating table.
  • Division of sigmoid colon:
    • Creating an opening in the mesocolon under the inferior mesenteric vessels.
    • Identifying the left ureter.
    • Cutting and ligating the inferior mesenteric artery and vein.
    • Cutting the sigmoid colon using GIA stapler.
  • View from the head end of the operating table.
  • Hysterectomy pt. 1:
    • Cutting and ligating the ovarica arteries and veins (right side shown).
    • Cutting and ligating the round ligaments (right side shown).
  • Total mesorectal excision (TME) pt. 1:
    • Identifying the sympathetic hypogastric nerves.
    • Dissection between pelvic wall and posterior rectum avoiding damage to the nerves.
  • Dissection of ureters down to the bladder (right side shown).
  • Hysterectomy pt. 2:
    • Cutting and ligating the uterine arteries and veins (right side shown).
    • Incising the vaginal top and dividing the vagina.
    • Suturing the distal vagina.
  • TME pt. 2:
    • Dissection between posterior vaginal wall and anterior rectum.
    • End of TME. Hypogastric nerves remain undamaged.
  • Dissection of ureters complete.
  • The uterus with two myoma, ovaries and fallopian tubes.
  • Division of distal rectum using TA stapler.
  • Operation specimen:
    • Colon segment, rectum and uterus.
    • Distal resection edge.
    • Intact mesorectal fascia.
    • Tumor infiltration right below the cervix.
  • Anastomosis of colon and rectum:
    • Cutting left colonic flexure to mobilize descending colon.
    • Placing head of CEEA stapler in the colon using a pouch suture.
    • Inserting CEEA stapler in the rectum.
    • Closing and firing CEEA stapler creating end-to-end anastomosis.
    • Distal ring sent to pathologic examination.
  • Colon extending unhindered down into the pelvis.

Watch the low anterior resection video

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