Abstracts
1998 Digestive Disease Week

#1003

LAPAROSCOPIC TOTAL MESORECTAL EXCISION AND AUTONOMIC NERVE PRESERVATION IN A CADAVER MODEL. BL Jerby, H Kessler, PW Marcello, T Gramlich, JW Milsom. Departments of Colorectal Surgery and Pathology. The Cleveland Clinic Foundation. Cleveland, OH.

Although proctectomy with total mesorectal excision (TME) and autonomic nerve preservation (ANP) is becoming accepted as the optimal technique for rectal cancer surgery, there are no studies verifying that this procedure can be done laparoscopically. The purpose of this study was to demonstrate, in a cadaver model, that TME with ANP can be performed laparoscopically in accordance with oncologic surgical principles. METHODS: TME with ANP was performed in 11 fresh cadavers (1 open, 10 laparoscopic). An autopsy was done after TME with bilateral autonomic nerve sampling at three levels (pelvic brim, sidewall, and lateral stalk). These end points were assessed: (1) length of remaining inferior mesenteric artery (IMA),
(2) length of remaining rectum (3) remaining mesenteric lymph nodes/mesorectum, (4) histologic confirmation of autonomic nerves, and (5) complications. The proctectomy specimens were inspected and photographed. RESULTS: The median length of the remaining IMA was 3 (range, 1-11) mm and only one lymph node was found at the base of the IMA in one cadaver. The median length of remaining rectum was 1 (range, 0.5 - 2) cm from the anorectal junction and there was no residual mesorectum in any cadaver. Pathologically, an intact mesorectum was confirmed in all specimens. All nerves identified and preserved at each of the three levels during the procedures were histologically confirmed to be autonomic tissue. (66/66 specimens). One enterotomy occurred in one cadaver. CONCLUSION: Laparoscopic TME can be performed according to oncologic principles and anatomic criteria with high ligation of the IMA and mesenteric lymphadenectomy. In addition, ANP may be consistently accomplished laparoscopically.

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