Incidence and patterns of recurrence after intersphincteric resection for very low rectal adenocarcinoma. This paper discusses the method used for a robotic intersphincteric resection and coloanal anastomosis. Survival and functional and oncological outcomes following. Comparison of functional results and quality of life between. By contrast, intersphincteric resection allows sphincter salvage even in low tumors and is now widely accepted among experts in the field of colorectal surgery. From july 2004 to december 2009, patients with rectal cancer below 6 cm from anal verge treated by laparoscopic curative intersphincteric resection and abdominoperineal resection were included in a retrospective comparative study. Transanal approach for intersphincteric resection of rectal cancer in. Fourarm single docking full robotic surgery for low rectal cancer. Intersphincteric resection has long passed the status of a new procedure for low rectal cancer. In addition to distal resection margin, there were no significant differences in clinicopathological parameters and postoperative complications between the three groups. This metaanalysis aims at comparing laparoscopic intersphincteric resection lisr with conventional open isr oisr for low. In recent years, intersphincteric resection for low rectal cancer has been offered and performed in patients as an alternative to abdominoperineal resection.
Longterm results of extended intersphincteric resection. Laparoscopic intersphincteric resection with diverting. The present video shows a 38yearold male patient with fap with a synchronous 4cm ulcerative rectal cancer at 3cm above the anal verge. Pdf intersphincteric resection for low rectal cancer. Perineal wound complications are very frequent after proctectomies for cd, however in our patients wound problems were superficial, secondary to the limited intersphincteric resection, avoiding tension on the wound. In this video article, we show the performance of a transanal approach for intersphincteric resection isr of rectal cancer in a patient with a huge prostatic hypertrophy. Intersphincteric resection has similar longterm oncologic. Intersphincteric resection isr has rapidly increased worldwide. Operation time was shorter in hartmanns procedure as compared with intersphincteric abdominoperineal excision, median 174 and 256 min, p resection margin were comparable. The introduction of intersphincteric resection isr is one of the recent advances in the surgical treatment of lower rectal cancer. Laparoscopic intersphincteric resection versus an open approach. Low rectal cancer is traditionally treated by abdominoperineal resection. Perianal procedure for intersphincteric resection isr. Click subscribe to this channel for the most uptodate content.
Isr of low rectal tumours is a surgical technique extending rectal resection into the intersphincteric space. Laparoscopic intersphincteric resection using needlescopic. The technique of intersphincteric resection permits sphincter preservation with good. Intersphincteric proctectomy with endcolostomy for.
Intersphincteric resection and coloanal anastomosis in. The patient underwent seton placement 6 weeks prior. Contact us to feature your surgery in an upcoming webcast. Intersphincteric resection for low rectal tumors 20120712. It is usually performed in patients with colorectal cancer low in the rectum where the cancer does not affect the anal sphincter muscles, but where these muscles are weak and there is a high risk of severe faecal incontinence after surgery. Intersphincteric resection for very low rectal cancer. Amelioration of intersphincteric resection for low rectal cancer concentrate on defaecation function a video vignette. However, many patients experience anorectal symptoms and defecatory dysfunction after isr.
Intersphincteric resection isr was first introduced as an anuspreserving operation for very low rectal cancer approximately two decades ago 1. Recently, transanal tme has attracted intense attention as a promising alternative to laparoscopic tme. In this video, authors present a robotassisted low anterior resection with tme and intersphincteric resection coloanal anastomosis without. Transanal approach for intersphincteric resection of. Download citation comparison of functional results and quality of life. Several studies have demonstrated the acceptable outcomes of isr in terms of morbidity, oncologic safety, and postoperative anal functions, and isr has been. In the treatment of distal rectal cancer, abdominoperineal resection is traditionally performed.
Safety and feasibility of laparoscopic intersphincteric resection for a lower rectal tumor nobuhisa matsuhashi, takao takahashi, toshiyuki tanahashi, satoshi matsui, hisashi imai, yoshihiro tanaka, kazuya yamaguchi, shinji osada and kazuhiro yoshida department of surgical oncology, gifu university school of medicine, gifu 5011194, japan. Plane for the intersphincteric resection and laterotoend hand sewn coloanal anastomosis. The intersphincteric resection for low rectal cancers provides a challenge for open approach and also for laparoscopic method. Transanal intersphincteric proctectomy and abdominal. An intersphincteric apr abdominoperineal resection is an operation to remove the internal anal sphincter and rectum. Laparoscopic tme with intersphincteric dissection and coloanal anastomosis in ultralow rectal cance society of american gastrointestinal and endoscopic surgeons sages. A total of 62 consecutive patients with very low rectal cancer who. Keywords transanal approach total mesorectal excision intersphincteric resection rectal cancer prostatic hypertrophy introduction. Anastomotic stricture after ultralow anterior resection or. With the introduction of sharp rectal dissection along the mesorectum total mesorectal excision, tme either from the abdomen or transanal tme bottomtoup approach, this procedural. Schiessel r, karnerhanusch j, herbst f, teleky b, wunderlich m. Lower margin of the tumor is assessed, and proper type of isr partial, subtotal, or total is selected. Total mesorectal excision for midrectal cancer without.
Recently, this procedure was performed using laparoscopy lap. Intersphincteric apr shahab siddiqi, colorectal surgeon. Digital rectal examination is performed to identify intersphincteric groove, and 0. There have been reports of laparoscopic isr 3, 4, but discussion of the specific techniques used in this laparoscopic surgical procedure have not been sufficient. Intersphincteric resection for low rectal tumors 20120712 unknown on. Robotic intersphincteric resection dr jitender rohila, dr sanjeev kumar, dr avanish saklani tata memorial centre, mumbai, india this video is from the live presentation at the 2019 robotic surgeons council of india meeting. Anastomotic stricture following colorectal cancer surgery is not a rare complication, but proper management of anastomotic stricture located close to the anal verge is uncertain. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity and to improve both the oncological as well as the functional outcomes, have been emerged. Laparoscopic versus conventional open surgery in intersphincteric. Laparoscopic tme with intersphincteric dissection and. The purpose of this study was to assess the longterm oncological and functional outcomes of intersphincteric resection for t2 and t3 rectal cancer situated below 4 cm from the anal verge. Laparoscopic intersphincteric resection for low rectal. Intersphincteric resection isr is the final procedure used to preserve the anal function in very low rectal cancer patients.
After initial complete clinical response, during a watchandwait protocol, a lesion regrowth was observed 14 months later, necessitating a surgical oncological approach. Long term results of modified intersphincteric resections. Threeyear cumulative local recurrence rates were 7. An overview of this procedure, including indications, oncological and functional results based on current literature, is presented herein. Delayed anastomotic leakage following laparoscopic. Although it is not standard procedure, transanal intersphincteric resection isr was introduced and has been increasingly performed as an ultimate surgical treatment for extremely low rectal cancer. Completely abdominal approach laparoscopic partial. In this video article, we show the performance of a transanal approach for intersphincteric resection isr of rectal cancer in a patient with a. This intraoperative video shows the performance of a transanal total mesorectal excision commencing with an intersphincteric dissection for a patient with a low t1 rectal cancer and concluding with a handsewn coloanal anastomosis. Get your kindle here, or download a free kindle reading app.
Unlimited access to the largest elibrary of professional videos, images, documents, courses. Pdf intersphincteric resection for very low rectal cancer. However, the recognition of shorter safe distal resection line, intersphincteric resection technique has given a chance of sphinctersaving surgery for patients with distal rectal cancer during last two decades and still is being performed as an alternative choice of abdominoperineal resection. Pdf intersphincteric resection isr has rapidly increased worldwide including laparoscopic. Isr is a surgical technique to preserve sphincter function that was first described by schiessel et al. Intersphincteric resection isr has become an increasingly popular optional surgical tool for the treatment of very low rectal cancer.
Here we describe the technical points while performing the surgery as well as shortterm results of our own series. Laparoscopic intersphincteric resection and handsewn. Although it was initially utilized to treat inflammatory bowel disease 2, its performance in. Robotic intersphincteric resection isr has been introduced for sphincterpreservation in the treatment of low rectal cancer. Intersphincteric resection and coloanal reconstruction. Intersphincteric resection irs is a surgical technique used to preserve sphincter function, mainly cases of low rectal cancer located less than 5 cm from the anal verge 1, 2. Laparoscopic intersphincteric resection versus an open. However, this operation is not wellreceived by patients, since it results in a permanent colostomy. Low tumors of the rectum are traditionally treated with amputation of the rectum. Similarly, there is enough evidence to consider laparoscopic surgery as feasible and oncologically safe for rectal cancer. This video shows a method for performing a transanal proctectomy for ulcerative colitis in a patient with prior ileorectal anastomosis and now with a rectovaginal fistula.
Amelioration of intersphincteric resection for low rectal. Department of general surgery, zhujiang hospital, southern medical university, guangzhou, guangdong, china. Operative techniques of intersphincteric resection for lower rectal. Anorectal complications after robotic intersphincteric. Intersphincteric resection isr has been performed since 1994, when schiessel et al. This is a ks national robotic surgery awards finalist, entered by dr jitender rohila, coproduced by dr sanjeev kumar, dr avanish saklani. The treatment of rectal cancer has evolved from being solely a surgical endeavor to a multidisciplinary practice.
Laparoscopic tme websurg, the online university of ircad. Advantages of the transanal approach for intersphincteric. This video describes a repair of fistula in ano by ligation of intersphincteric fistula tract. Robotic topdown intersphincteric resection with ipaa for fa. Intersphincteric resection for low rectal tumors 201207. Traditional intersphincteric resection is a technically demanding procedure that required a perineal approach dissection and a handsewn coloanal anastomosis. This study aimed to investigate risk factors and management strategies for anastomotic stricture after ultralow anterior resection ular. Advantages of the laparoscopic approach for intersphincteric resection. Laparoscopic ultralow anterior resection with intersphincteric dissection and delayed coloanal anastomosis in the tatme era a video vignette. Member benefits include resources such as the comprehensive video and image libraries, and document library available to assist members with the creation of patient educational materials or for resident educational opportunities. We report our clinical experience of the lapisr procedure carried out using needlescopic instruments. The distal resection line may be at the intersphincteric groove total isr.