Total laparoscopic sigmoid and rectal surgery combined with transanal endoscopic microsurgery

Objective To investigate the feasibility and short-term outcomes of total laparoscopic sigmoid and rectal surgery combined with transanal endoscopic microsurgery (TEM).Methods The clinical data of 26 patients with colorectal carcinoma treated by total laparoscopic surgery with TEM between May 2010 and May 2011 in the Shanghai Ruijin Hospital were retrospectively analyzed.Results All the 26 operations were successfully accomplished laparoscopically.There was no conversion to open procedure.No diverting ileostomy was made.The mean operative time was (151.6±25.9) min.The mean blood loss was (200.2±114.7) ml.The mean time to first flatus was (2.0±0.5) d.The mean tumor size was (3.0±0.7) cm and all resection margins were negative.The mean number of lymph nodes harvested was (12.9±2.2).Six patients developed postoperative anastomotic leakage,all of who had tumors in the lower rectum.There were no ureteral injury,intestinal obstruction,or pulmonary infection.Conclusions Total laparoscopic sigmoid and rectal surgery combined with TEM is a safe and feasible minimally invasive surgery.It is an improvement by combining laparoscopic skills with the concept of ratural orifice transluminal endoscopic surgery. Key words: Colorectal neoplasms;  Surgical procedures;  Laporoscopy;  Transanal endoscopic microsurgery