Video Laparoscopic surgery has many advantages over open surgery (laparotomy): faster recovery, smaller abdominal incisions and less pain after surgery.
Recently, rectal video access techniques, such as TAMIS, have allowed the removal of superficial tumours located in the rectum or even in the final segments of the sigmoid colon.
This video presents the case of an elderly patient with two synchronous tumours: one advanced in sigmoid colon and another, bulky but in the initial stage, located in the middle rectum.
The standard procedure to be adopted would be to remove the entire rectum together with the sigmoid colon, buiding a diverting ileostomy.
Because it was a patient with several serious health problems who did not accept a stoma, and considering that the lesion of the rectum appeared not to invade the deep layers of the organ, we chose – in agreement with the patient and her relatives – to combine two procedures at the same time.
At first, the distal tumour was removed from the rectum by TAMIS. Due to the size of the lesion and because of its extraperitoneal location (it was inside the pelvis and outside the abdomen), we chose to leave the resection open.
Subsequently, a video laparoscopic rectosigmoidectomy following oncologic stadards was performed by medial to lateral access, and the superior rectum was stapled above the resection of the first lesion.
An end-to-end anastomosis was then performed by double stapling and, finally, we did an endoscopic visualization of the anastomosis and lesion, for final revision.
The patient had an excellent clinical outcome and the surgical specimen demonstrated the adequacy of the resections from an oncological point of view.