Abstract
To assess the feasibility and safety of laparoscopic rectal surgery without abdominal scar. A total of 23 patients of rectal cancer were operated by laparoscopy with the assistance of PPH (procedure for prolapse and hemorrhoids) anal expander and TEM (transanal endoscopic microsurgery) outer-shell according to the principle of TME (total mesorectal excision). All operations were successfully accomplished laparoscopically. There was no conversion into an open procedure. The average operative duration was 129 (105 - 211) minutes. The intra-operative blood loss volume was 152 (85 - 420) ml. No immediate or delayed injury of urinary duct and other intra-operative severe complications, such as massive hemorrhage of presacral venous plexus, occurred. There was no pelvic infection or anastomotic stoma fistula during the post-operative period. The average follow-up period was 13.4 months. Neither anastomotic stoma recurrence nor Trocar implantation occurred. The laparoscopic technique of hybrid NOTES (Natural Orifice Transluminal Endoscopic Surgery), plus PPH/TEM is both feasible and convenient for selective rectal cancer surgery. There is no need for extra abdominal incision. It is recommended for laparoscopic rectal surgery.
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