Surgical Technique and Difficult Situations from Alois Fuerst (Laparoscopic)

Standardisation of the laparoscopic surgical procedure in rectal cancer has favourable effects in terms of security aspects, economic workflow and teaching factors. Self-evident the oncological aspects of surgical quality must be taken into account. The autonomic nerve-sparing TME technique is the gold standard in rectal cancer resection even in conventional or laparoscopic procedure. In open surgery, most surgeons start the operation left laterally mobilising the sigmoid colon first. In the laparoscopic technique, we recommend the medial to lateral approach starting the preparation at the right side of the rectum and the sigmoid colon. Following this approach, the nerve-sparing TME technique can be performed easier and the identification of the left ureter may be simplified. Since more than 10 years, we perform a standardised “laparoscopic ten-step TME procedure” in rectal cancer: