Web-Exclusive Content: Didactic Video Collection
Fu, Chuangang M.D.; Zhou, Zhuqing M.D.; Ji, Fang M.D.
Department of Colorectal Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
Funding/Support: None reported.
Financial Disclosure: None reported.
Informed consent was obtained from the patient.
Correspondence: Chuangang Fu, M.D., Department of Colorectal Surgery, Shanghai East Hospital, Tongji University, 200120, No. 150 Jimo Rd, Pudong District, Shanghai, China. E-mail: [email protected]
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
TEACHING POINT
In this article, we show 3-dimensional laparoscopic natural orifice specimen extraction surgery (NOSES) for rectal prolapse. We demonstrate the key steps of the procedure, along with related technical points, to provide a technical demonstration for the surgical treatment of progressive, reducible rectal prolapse. We believe that this article is valuable for all the researchers and surgeons who are interested in rectal prolapse.
- Preoperative examination: physical examination, magnetic resonance imaging, and colonoscope.
- Operation position: patient needs to be placed in a lithotomy position with head down tilt and left tilt. Legs need to be placed to the same plane of the body. Surgeon stands on the left side of patient and assistant stands oppositely. The camera holder stands on the left side of the patient’s head. Monitor is placed in front of patient between legs.
- Port placement: 5-trocar method.
- Surgical procedure.
- Mobilize the redundant sigmoid colon and rectum.
- Open the Douglas pouch and both sides of peritoneum around rectum. Do not perform further dissection, and protect the pelvic nerve.
- Fully dissect the posterior rectal space to hiatal ligament.
- Remove redundant peritoneum.
- Tie the distal rectum and flush the distal rectal lumen.
- Transect redundant sigmoid colon and rectum.
- Remove specimen by establishing a clean tunnel with plastic sleeve through the distal rectum and anus, and put the anvil into abdomen.
- Place the anvil into proximal colon and tie colon at the base with an endoloop.
- Perform anastomosis and closure.
- Rebuild pelvic floor.
- Potential complications: abdominal infection, anastomotic fistula, and nerve dysfunction.
VIDEO SUMMARY
This video demonstrates that it is important to fully mobilize the redundant peritoneum. Do not further dissect when opening both sides of peritoneum around rectum. Posterior rectal space should be dissected deeply. Finally, it is significant to rebuild pelvic floor.
KEY IMAGE
See video on the DCR YouTube Channel at https://youtu.be/qbi9oBAQjd4
Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Colon and Rectal Surgeons.
