Changes in Surgical Procedures for Rectal Cancer
The rectum is located in the pelvis and surrounded by nerves and important organs (seminal vesicles and prostate in men, vagina and uterus in women). Advanced techniques are required to remove rectal tumors without damaging these organs. In the past, rectal cancer surgery was performed through a large incision in the abdomen. Laparoscopic surgery, in which a laparoscope and forceps are inserted through a small hole in the abdomen, was first performed in Japan in 1991. Laparoscopic surgery had rapidly increased in popularity due to its advantages such as smaller wounds, less pain, faster postoperative recovery, and less blood loss. Furthermore, in 2018, robotic-assisted laparoscopic surgery was covered by insurance, allowing for more delicate surgery. However, transabdominal approach is unfavorable in patients with lower rectal cancer, especially for those who has narrow pelvic anatomy or huge tumors. Therefore, we have introduced not only the intraperitoneal approach but also the transanal approach for lower rectal cancer.
Transanal approach for lower rectal cancer
In addition to the conventional abdominal approach, a laparoscope and forceps are inserted through the anus to remove the rectum (Fig.). Transanal approach for the deep pelvic region provides good exposure and facilitates the distal mesorectal excision. This approach is especially effective in difficult cases such as obese cases, low rectal cancer cases, and cases with a narrow pelvis. A good visual field contributes to preserving postoperative anal and urinary function. Furthermore, the two-teams approach simultaneously from both the abdomen and the anus, significantly shortening the operative time and consequently reducing the invasiveness to the patient. We introduced the transanal approach in 2018 and have performed approximately 180 cases so far, which is one of the highest numbers in the country. In recent years, we have combined the robotic abdominal approach with the transanal approach to perform minimally invasive surgery with fewer complications (Photo).
