title: Laparoscopically assisted anorectoplasty using perineal ultrasonographic guide: a preliminary report.
abstract: OBJECTIVE
  As minimal invasive surgery, laparoscopically assisted anorectal pull-through has been reported with new devices. However, it is not easy to create an accurate pull-through canal (PTC) because of the narrow space between the urethra and puborectal sling. The authors describe a new method using perineal ultrasonography.
  
  
  METHODS
  The rectourethral prostatic fistula was dissected laparoscopically. Externally, electrostimulation identified the center of the muscle contraction, over which a 1.2-cm skin incision was made, and the lower part of PTC was created by hemostat forceps guided by electrostimulation. An ultrasonographic probe applied to the perineum demonstrated the urethra, and the forceps was advanced behind the urethra into the pelvic cavity using the ultrasonographic guide. Anorectal pull-through was performed after dilatation of the PTC with dilators.
  
  
  RESULTS
  The authors applied this procedure in 5 cases of male high and intermediate anomalies. Surgical damages to the urethra and the levator and vertical muscles were not encountered. Postoperative fluoroscopic study demonstrated good anterior angulation and intact contraction and relaxation of those muscles.
  
  
  CONCLUSIONS
  The combination of laparoscopic dissection, pinpointing the center of anal sphincter by electrostimulation, and identification of the urethra by ultrasonographic images from the perineum facilitated creation of appropriate PTC in the muscle complex.
authors.affiliation: Department of Pediatric Surgery, Osaka Medical Center, Research Institute for Maternal and Child Health, Osaka 594-1101, Japan. kubota@mch.pref.osaka.jp
authors.forename: Akio
authors.initials: A
authors.lastname: Kubota
authors.forename: Hisayoshi
authors.initials: H
authors.lastname: Kawahara
authors.forename: Hiroomi
authors.initials: H
authors.lastname: Okuyama
authors.forename: Takaharu
authors.initials: T
authors.lastname: Oue
authors.forename: Yuko
authors.initials: Y
authors.lastname: Tazuke
authors.forename: Natsumi
authors.initials: N
authors.lastname: Tanaka
authors.forename: Akira
authors.initials: A
authors.lastname: Okada
mesh_terms: D001003:Anal Canal / Q000000981:diagnostic imaging* / Q000601:surgery*; D001006:Anus, Imperforate / Q000000981:diagnostic imaging* / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D010535:Laparoscopy; D008297:Male; D010502:Perineum / Q000000981:diagnostic imaging; D012007:Rectum / Q000000981:diagnostic imaging* / Q000601:surgery*; D014463:Ultrasonography