APPLICATION OF THE COMPLEX OF TECHICAL MANEUVERS DURING LAPAROSCOPIC TOTAL MESORECTAL EXCISION

Aim. The aim of this study is to describe a technique that facilitate the dissection of mesorectum and the rectal transection during laparoscopic total mesorectal excision (LTME) and demonstrate the primary results of its application. Materials and methods. A retrospective-prospective non-randomized study was conducted in the department of coloproctology of the Ryazan State Clinical Hospital in the period from January 2011 to September 2016. One hundred thirty-four patients with verified rectal cancer who underwent laparoscopic low anterior resection of the rectum with total mesorectal excision were included in the present study. Sixty-seven patients who underwent LTME with a new surgical technique (modified LTME) in the period from May 2014 to September 2016 were included in the main group. During modified LTME we used two extracorporeal "puppet" sutures to fix the uterus in women and the pelvic peritoneum in men, polypropylene ligatures and cotton tape for traction of the rectum, and the special device for pressing on the peritoneum. Sixty-seven patients who underwent traditional LTME in the period from January 2011 to April 2014 were included in the control group. Results. Macroscopic grading of the specimen in the main group was complete (Grade 3) in 58 cases (86.6%). In the control group, grading was complete in 43 cases (64.2%). These results showed statistical significance between the groups (p=0.002). Macroscopic quality of the specimen was near complete (Grade 2) in 13 patients (19.4%), and in 3 patients (4.4%) in the control group (p=0.007). The number of incomplete specimens (Grade 1) was not significant difference in the compared groups (p=0.15). The main number of stapler firings was 1.54±0.6 in the main group and 1.81±0.7 in the control group (p=0.02). One firing was needed in 35 cases (52.2%) in the main group, and in 22 cases in the control group (p=0.018). Other outcomes were comparable between the groups. Conclusion. The use of modified LTME technique led to a significant improvement in the quality of specimens (p=0.002) and a decrease in the number of firings by a linear stapler (p=0.02).