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.