腹腔鏡下低位前方切除術における大腸内視鏡を用いた直腸反転法

New rectal prolapsing method using colonoscopy for laparoscopic low anterior resection

◆要旨：筆者らは腹腔鏡下低位前方切除術における大腸内視鏡を用いた直腸反転法を考案した．本法の手術手技と特徴を報告する．直腸の口側切離線を自動縫合器で切離した後，口側断端内腔に縫合糸を通し，ループとしておく．肛門から大腸内視鏡を挿入し，内視鏡用把持鉗子でこの糸を把持する．大腸内視鏡を引き抜くことで反転操作が開始される．反転操作中，常に腸管軸に沿った牽引力が口側断端にかかるため，直腸の反転が円滑である．また，反転操作は内視鏡施行医が単独で施行可能であり，腹腔側からの反転操作の介助は不要である．

　Laparoscopic low anterior resection（LAR）for lower rectal cancer has some technical difficulties. Especially, distal transection of rectum is the most difficult point during this procedure. Recently, some reports have shown the effectiveness of the prolapsing method to resolve this problem.

　We applied colonoscopy during the turn over procedure. The thread is passed through the inner lumen of the rectum. Colonoscopy is inserted from the anus and the thread which is shown in the rectum is grasped by endscopical forceps. Colonoscopy is pulled back to the anus and the rectum turns over gradually. Because of using flexible fiberscope, the traction brought to the cut end of the rectum is always parallel with the bowel axis. It lets the rectum turn over easily. Our method enables the endoscopist to perform the turn over procedure alone without particular assistance from the operator from the abdominal side, which is an advantage for laparoscopic surgery.