Modified Serial Techniques “ASTRO” Faciliated Laparoscopic Total Mesorectal Excision for ultralow-Lying Rectal Cancer in Obese Male Patients (original) (raw)
Background Laparoscopic total mesorectal excision (LaTME) is technically challenging for ultralow-lying rectal cancer in obese male patients. Herein, we introduced modified serial techniques “ASTRO” to facilitate LaTME, and the short-term outcomes were presented. Methods A prospective study (NCT05067413) was conducted between December 2020 and January 2022. The modified serial surgical techniques “ASTRO” included 5 key steps: 1) Anterior peritoneal reflection (APR) dissection at the highest line along with a "n"-shaped membrane bridge; 2) Suspending the APR with a purse-string suture through the bladder peritoneum to enlarge the operating space of the anterior rectal wall; 3) Traction and counter-traction continuously of the rectum applied with a cotton tape around the rectum; 4) Resection of the pelvic rectum on tripartition, followed by the sequence of "posterior > anterior > lateral" principle; 5) the trans-anterior Obturator nerve gateway was adapted to...
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