Laparoscopic restorative total proctocolectomy with mucosal resection

PURPOSE: Laparoscope-assisted restorative proctocolectomy is an alternative to conventional surgery for the treatment of ulcerative colitis. We present our approach of laparoscopic dissection and transection of rectum combined with transanal rectal mucosectomy. METHODS: A total of 21 patients underwent laparoscopic total proctocolectomy with transanal rectal mucosectomy for ulcerative colitis. The rectum was mobilized and transected by using a combination of laparoscopic dissection and transanal mucosectomy without hand-assist or mini-aparotomy. The extent of laparoscopic dissection and the transection method varied according to the difficulty of pelvic dissection or the surgeons experience (early-phase method: laparoscopic transection of the muscular- cuff after transanal mucosectomy; intermediate- phase method: transection of the posterior side transanally and anteriolateral side laparoscopically; and recent- phase method: laparoscopic dissection down to the pelvic outlet and transanal circumferential transection of the rectum after mucosectomy). RESULTS: Using this approach, the median operative time was 404 minutes and the median operative blood loss was 120 g. There was no operative mortality, and no patients reported sexual or urinary complications during short- term follow-up. CONCLUSIONS: Laparoscopic total proctocolectomy for the treatment of ulcerative colitis is a feasible approach that demonstrates excellent views of the pelvis, which could be advantageous compared with conventional surgery. A stepbystep approach according to the surgeons experience and the difficulty of pelvic dissection may help minimize the risk of pelvic autonomic nerve injury.