title: Laparoscopic intersphincteric resection using needlescopic instruments.
abstract: Intersphincteric resection (ISR) is a procedure designed to preserve anal function in cases with very low rectal cancer. We report our clinical experience with laparoscopic ISR (Lap ISR) performed using needlescopic instruments. First, a camera port is created at the umbilicus. Two 5-mm ports are then inserted at the right upper and lower quadrants. Two needlescopic forceps (Endo-Relief(™) Hope Denshi Co., Chiba, Japan) are inserted at the left upper and lower quadrants. We then perform the following procedures; ligation of the inferior mesenteric artery and vein, total mesorectal excision and dissection of the intersphincteric space. After the transanal intersphincteric dissection, the specimen is extracted through the anus and a hand -sewn coloanal anastomosis is performed. The covering ileostomy is finally created at the right upper port. We performed Lap ISR using needlescopic forceps in two patients with very low rectal cancer. In both cases, we were able to perform this procedure without insertion of an additional port or to change the needlescopic forceps to conventional 5-mm forceps. Lap ISR with needlescopic instruments is a feasible procedure for minimally invasive surgery.
authors.affiliation: Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Sakamoto
authors.affiliation: Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Okazawa
authors.affiliation: Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan.
authors.forename: Rina
authors.initials: R
authors.lastname: Takahashi
authors.affiliation: Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan.
authors.forename: Kiichi
authors.initials: K
authors.lastname: Sugimoto
authors.affiliation: Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Komiyama
authors.affiliation: Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kojima
authors.affiliation: Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan.
authors.forename: Michitoshi
authors.initials: M
authors.lastname: Goto
authors.affiliation: Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Okuzawa
authors.affiliation: Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, Tokyo, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Tomiki
keywords: Laparoscopic intersphincteric resection; needlescopic instruments; rectal cancer