Multiport Laparoscopic TME with Coloanal Anastomosis

Abstract

Total mesorectal excision (TME) is the gold standard technique for the surgical treatment of rectal cancer. Despite the benefits of minimally invasive surgery, laparoscopic TME is a technically challenging procedure with a long learning curve. Quality of surgery is evaluated by completeness of the mesorectal envelope and resection margins. Other objectives are sphincter preservation and functional outcome. The concept for sphincter-saving resection is related to the distance between the tumor and the anal sphincter. It is now generally accepted that involvement of circumferential resection margin (CRM) is an important risk factor of local recurrence, and considerably circumferential resection margin is more relevant than the distal resection margin. The technique of intersphincteric resection has been developed to move to a more conservative (sphincter salvage) concept in lower rectal cancer. In this chapter we describe step-by-step our standardized technique of multiport laparoscopic TME, with or without an intersphincteric resection for low rectal cancer.