A minimally invasive approach to rectal cancer--sacrolaparoscopic approach.
BACKGROUND/AIMS: To investigate the feasibility of a technique with minimal skin incision, while retaining a rate of cure and safety equivalent to conventional rectal amputation, by making use of the advantages of laparoscopic procedures, we performed a minimally invasive laparoscopic rectal amputation. METHODOLOGY: Six patients suffering from rectal cancer with cardiac and/or respiratory disorders underwent laparoscope-assisted rectal amputation. The procedure was performed in three steps: 1) sacral approach, 2) laparoscope-assisted abdominal approach under CO2 insufflation, and 3) extracorporeal resection of the inferior mesenteric artery (IMA) and stoma making without CO2 insufflation. RESULTS: Intra-operative cardiopulmonary functions were maintained within normal range during CO2 insufflation. Although all patients had severe respiratory or cardiac disorder or diabetes mellitus, no complications were observed during and after surgery. The post-operative course was uneventful for our patients, each of whom could eat on the first post-operative day and walk on the third post-operative day. All patients were discharged from the hospital uneventfully. CONCLUSIONS: Laparoscope-assisted rectal amputation is technically feasible, adequate tumor excision can be achieved with it and post-operative recovery is improved. Sacrolaparoscopic rectal amputation appears to be a safe alternative procedure for patients with rectal cancer and even with severe cardiopulmonary disorders.