title: Transanal rectal dissection: a procedure to assist achievement of laparoscopic total mesorectal excision for bulky tumor in the narrow pelvis.
abstract: BACKGROUND
  Laparoscopic approaches for colorectal surgery have been improved recently; however, it is often difficult to achieve total mesorectal excision (TME) for lower rectal cancer laparoscopically because of a narrow pelvis and a thickened mesentery.
  
  
  METHODS
  TME was successfully performed in 6 patients (4 men, 2 women) with dissection of the rectum transanally from the anal side of the tumor. The preoperative stage was T3N1M0 in 1 patient and T3N0M0 in 5 patients. The mean body mass index was 29.8 kg/m(2) (range, 28.7-31.2 kg/m(2)), and the mean tumor size was 46.5 mm (range, 30-60 mm).
  
  
  RESULTS
  The mean duration of the anal portion of the operation was 64 minutes (56 minutes in women, 79 minutes in men). No complications occurred during surgery or postoperatively.
  
  
  CONCLUSIONS
  This technique is a simple and effective procedure for successfully performing laparoscopic TME of lower rectal cancer in patients with bulky tumors, narrow pelvises, and thickened mesenteries.
authors.affiliation: Department of General and Gastroenterological Surgery, Toho University Medical Center, Omori Hospital, Tokyo, Japan. kingkong@med.toho-u.ac.jp
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Funahashi
authors.forename: Junichi
authors.initials: J
authors.lastname: Koike
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Teramoto
authors.forename: Naoyasu
authors.initials: N
authors.lastname: Saito
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shiokawa
authors.forename: Akiharu
authors.initials: A
authors.lastname: Kurihara
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Kaneko
authors.forename: Kentaro
authors.initials: K
authors.lastname: Shirasaka
authors.forename: Hironori
authors.initials: H
authors.lastname: Kaneko