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Laparoscopic restorative proctocolectomy

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Tips And Tricks For Autonomic Nerve Sparing Dissection In Laparoscopic Tme For Rectal Cancer

Didactics And Hands-on Hints
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Asoglu Oktar,
Istanbul Faculty Of Medicine,
Istanbul

PERSONAL COMMENTS:
Laparoscopic autonomic nerve sparing total mesorectal excision requires experience, surgical skill and adequete knowledge of open colorectal surgery. In unexperienced hands, oncological outcome and longterm qualitiy of life can be very poor.

ABSTRACT:
The aim of rectal cancer surgery is to ensure good oncological outcome and maintain a good quality of life. What has laparoscopy provided us in this aspect? Using laparoscopy and considering the anatomical relationship of the superior hypogastric plexsus(SHP) and inferior mesenteric artery(IMA) artery, the best place to ligate the IMA seems to be at its aortic origin. This is because there is a small one cm clear distance between the SHP and IMA at this location. Laparoscopic magnification has enabled a clear view of this area. Therefore, we can obtain a good oncological surgery as well as protect the SHP. With laparoscopic surgery, we can protect the hypogastic nerves when mesorectal excision is performed staying in the correct anatomical plane. Additionally, surgery can be performed in a more comfortable position even in patients with a narrow pelvis. In the future laparoscopic total mesorectal excision for rectal cancer will become a gold standard.
Thoracoscopic repair of tracheo-esophageal fistula
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