Introduction: Obesity is a burgeoning problem worldwide. Although beneficial in obese patients, conventional laparoscopic mesorectal excision for rectal cancer is technically challenging, with a higher conversion rate to open compared with nonobese patients. We describe novel strategies to circumvent these difficulties.
Technique: The key steps are 1) lateral-to-medial colonic mobilization and left-sided mesorectal excision with the surgeon on the patient's right; 2) switching to the patient's left for right-sided mesorectal excision; 3) further rectal retraction with cotton tape and preperitoneal fat sling; and 4) caudal-to-cephalad mobilization of colon after distal transection, which facilitates extrapelvic mesenteric dissection and vessel ligation.
Results: These techniques optimize gravity to negate the lack of exposure due to visceral obesity. Triangulation is improved by changing the surgeon's position during mesorectal dissection. This allows accurate identification of anatomical planes and avoids excessive pneumoperitoneum pressures and Trendelenburg tilt.
Conclusions: Adopting these strategies can facilitate laparoscopic mesorectal excision in the obese patient and may reduce conversion to open.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/DCR.0000000000001319 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Deep learning-based pelvimetry in pelvic MRI volumes for pre-operative difficulty assessment of total mesorectal excision.
Surg Endosc
January 2025
Surgery Department, Meander Medical Centre, Maatweg, Amersfoort, 3818 TZ, Utrecht, The Netherlands.
Background: Specific pelvic bone dimensions have been identified as predictors of total mesorectal excision (TME) difficulty and outcomes. However, manual measurement of these dimensions (pelvimetry) is labor intensive and thus, anatomic criteria are not included in the pre-operative difficulty assessment. In this work, we propose an automated workflow for pelvimetry based on pre-operative magnetic resonance imaging (MRI) volumes.
View Article and Find Full Text PDFTreatment Pattern and Outcome of Locally Advanced Rectal Cancer in Resource-Constrained Countries: Experience at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.
JCO Glob Oncol
January 2025
Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN.
Purpose: Management of locally advanced rectal cancer (LARC) includes neoadjuvant chemoradiotherapy (NACRT) followed by total mesorectal excision. Recently, total neoadjuvant treatment (TNT) has gained attention. In developing countries, patients with rectal cancer often present at advanced stages.
View Article and Find Full Text PDFComputed Tomography Scan and Clinical-based Complete Response Prediction in Locally Advanced Rectal Cancer after Neoadjuvant Chemoradiotherapy: A Machine Learning Approach.
J Med Signals Sens
December 2024
Radiation Biology Research Center, Iran University of Medical Sciences, Tehran, Iran.
Background: Treatment of locally advanced rectal cancer (LARC) involves neoadjuvant chemoradiotherapy (nCRT), followed by total mesorectal excision. Examining the response to treatment is one of the most important factors in the follow-up of patients; therefore, in this study, radiomics patterns derived from pretreatment computed tomography images in rectal cancer and its relationship with treatment response measurement criteria have been investigated.
Methods: Fifty patients with rectal adenocarcinoma who were candidates for nCRT and surgery were included.
Key steps in exposure techniques for robotic total mesorectal excision (TME).
Tech Coloproctol
December 2024
Colorectal Surgery, Champalimaud Foundation, Av. Brasilia, 1400-038, Lisbon, Portugal.
Aim: The use of robotic surgery is increasing significantly. Specific training is fundamental to achieve high quality and better oncological outcomes. This work defines key exposure techniques in robotic total mesorectal excision (TME).
View Article and Find Full Text PDFPrediction model construction for the occurrence of LARS after neoadjuvant therapy combined with laparoscopic total mesorectal excision in male patients with mid-low rectal cancer.
Front Oncol
December 2024
Department of Basic Medicine, Sichuan Vocational College of Health and Rehabilitation, Zigong, Sichuan, China.
Background: Neoadjuvant chemoradiotherapy for rectal cancer improves surgical outcomes and reduces recurrence but can cause low anterior resection syndrome (LARS), affecting quality of life. This study aims to predict the risk of LARS in male patients with mid-low rectal cancer after laparoscopic total mesorectal excision (TME).
Methods: Clinical data from 203 male patients with mid-low rectal cancer who underwent neoadjuvant therapy and laparoscopic resection were collected.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!