Video summary: Low anterior resection
March 25, 2008 § 3 Comments
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).
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.
The Sterile Eye 
So nice of you to share your videos with us! Thanks!
Hope you find them interesting!
Thanks for sharing… can you put a full surgery video. I am a surgery resident doctor.