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Revista
de Gastroenterología del Perú |
Rev. Gastroenterol.
Perú 2004;
24 (1) : 29-33
A NEW TECHNIQUE OF
LAPAROSCOPIC SURGERY
FOR RECTAL DISEASE
T. Hanai, I. Uyama, M. Maruta, K. Maeda, M. Ito, T. Satoh, A. Horiguchi, S. Miyakawa
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| Figure
1.
UTERINE MANIPULATOR. This device is introduced from the vagina to
the uterus. The assistant controls the bar of it and removes
uterus from the field. The uterus is hatched up by this manipulator
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| Figure 2.
Tetron Tape joint the dull tip needle with obtuse angle, 1-0
(45mm) 3mm |
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| Figure
3.
Endometriosis betwen uterus and intestine with a severe adhesion.
Using UTERINE MANIPULATER during surgery allows a better view and
adequate movilization betwen uterus and bowel. By controlling the
UTERINE MANIPULATER it is easy to remove things with the scissors and
abrasive forceps |
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| Figure
4.
A straight needle is inserted from the abdominal wall into the
paritoneal cavity. The needle is passed through the broad ligament and
the needle is taken out at around the same site of insertion |
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| Figure
5.
The soft pre-sacral connective tissue on the left side is
dissected and passed through the contra-lateral cavity. Through this
hole the Diamond Flex Retractor is inserted behind the rectum. The tip
of the Diamond Flex Retractor is flexed and lifted up the rectum
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Figure
6-1.
Demonstrating the procedure by a model (please consider a
tube as the rectum): A needle is passed under the tube with a tape and
thread of the needle and cut |
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Figure
6-2.
The edge of the tape is grasped with forceps and pulled through
the loop and then tied up. By the grassping tape the tube can be
managed |
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| Figure
7-1.
The procedure is now performed in the real pelvis. A needle is
passed behind the rectum, and this is ligated with the tape and fixed
by clips. A needle is passed through and behind the rectum |
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| Figure
7-2.
The tape is ligated with forceps and fixed by clips |
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| Figure
7-3.
After the remnant rectum is irrigated with a 2lcc of destilled
water from anal side by a newly inverted irrigation system. Grasping
and lifting the tape, the rectum is divided by ENDO-stapler |
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| Figure
7-4.
An anvil head is fitted to the proximal colon and returned into
the abdomen. Double stapling technique is being performed |
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