Laparoscopic radical surgery for rectal cancer We have performed more than 100 cases of laparoscopic radical surgery for colorectal cancer in the past two years, and our experience has become increasingly mature. We have also carried out laparoscopic radical surgery for gastric cancer and laparoscopic gallbladder surgery and liver and pancreas surgery. This article only takes rectal cancer as an example to elaborate some points. (Figure shows laparoscopic rectal cancer miles surgery) Indications for laparoscopic rectal cancer 1 Tumors in upper, middle and lower rectal segments can be performed, with Dixon surgery in the upper middle segment and Miles surgery in the lower segment. 2 For middle and lower rectal cancer, after removing 2cm of rectum from the lower edge of tumor, the rectal ring of anal canal and anal raphe are intact and there is no tumor infiltration. Contraindications 1 Middle and upper rectal cancer has invaded the surrounding tissues, and there is infiltration or metastasis in the pelvic wall. 2Poor general condition, combined with other serious diseases that cannot tolerate general anesthesia. 3 Those who have a history of abdominopelvic surgery and are expected to have heavy adhesions. Preoperative preparation Female patients should routinely undergo vaginal examination to understand whether the tumor invades the posterior vaginal wall. If patients have urinary tract symptoms, cystoscopy or urography should be performed to understand whether there is tumor invasion. Anesthesia General anesthesia with tracheal intubation Position and trocar placement Modified lithotomy position, i.e., the right hip is straight and abducted about 45, the knee is straight, the right lower limb is lower than the abdomen, the left hip is slightly flexed 30, abducted 45 and the knee is flexed 45.
The left hip is slightly flexed by 30 and abducted by 45. The right upper extremity is adducted, and the left upper extremity is adducted or abducted as needed. The legs are positioned apart. The end of the operating table is separated directly to the sides. For the Dixon procedure, a modified lithotomy position is used for the Miles procedure. Adjust to a head-low-foot-high position at the start of surgery. Tilt to the right 15
The operator stands on the patient’s right side. The surgeon stands on the right side of the patient, the scope holder stands on the left side of the surgeon, and the assistant stands on the left side of the patient. In the open method, a 10-mm trocar was placed at the superior umbilical margin, inflated and placed into the laparoscope as an observation hole, a 12-mm trocar was placed in the right lower abdomen (intersection of the right midclavicular line and the line of the two anterior superior iliac spines) as the main operating hole, a 5-mm trocar was disposed of in the right midclavicular line at the level of the umbilicus as an auxiliary operating hole, and a 5-mm or 10-mm trocar was disposed of in the left midclavicular line at the level of the umbilicus as a secondary auxiliary operating hole, which was later enlarged to 4-5 cm as a specimen extraction incision.
The incision was enlarged to 4-5 cm for specimen retrieval.