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Laparoscopic cholecystectomy with only one port

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Ultra-low Anterior Resection With Intersphincteric Dissection With Colonic J-pouch Anal Anastomosis

Didactics And Hands-on Hints
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Kim Seon-hahn,
Korea University Anam Hospital,
Seoul


ABSTRACT:
Laparoscopic approach to rectal cancer is considered technically demanding because of the narrow confines of the pelvis and the lack of proper instrumentation Through this presentation we propose to show very low rectal lesions (<= 2 cm from the dentate line) can be successfully managed by abdominal laparoscopy and per anal intersphincteric dissection.

Patient profile
Our patient was a 53 year old female who presented with symptoms of per rectal bleeding and was found to have a rectal tumor 4 cm from the anal verge. The endorectal ultrasound confirmed the tumor to be T2NO and no sphincteric involvement. Therefore, she underwent laparoscopic ultra-low anterior resection with intersphincteric dissection and colonic J- pouch reconstruction. Four years after the primary surgery, she is disease free with good continence function

The steps of the procedure are as follows:
1. High ligation of the inferior mesenteric artery(IMA) and D3 lymph nodal clearance
2. Colonic mobilization
3. Pelvic dissection and Total Mesorectal Excision (TME)
4. Per anal intersphincteric dissection
5. Specimen pull through and distal transection
6. J-pouch construction
7. Hand-sewn colo-anal anastomosis
8. Protective covering stoma

Conclusion:
Combined laparoscopic and per anal intersphincteric dissection can be successfully used to resect very low rectal lesions with good oncologic and functional outcomes.
Laparoscopic Tubal Anastomosis
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