Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
Dis Colon Rectum. 2011 Apr;54(4):495-500. doi: 10.1007/DCR.0b013e318207026f.
A laparoscopic low anterior resection with double-stapling technique for lower rectal cancer is considered to be technically challenging because it is difficult to perform rectal transection and anastomosis in the narrow pelvic cavity.
We developed a new method for transecting the rectum with stapling a small number of cartridges. In laparoscopic low anterior resection, a 70-mm endovascular clip clamps the rectal wall at the anal side of the tumor. An endolinear stapler is applied at the rectal wall parallel and caudal to the 70-mm endovascular clip. A Nelaton catheter of 3.5 to 4.5 mm in outer diameter is inserted, and the loop of the Nelaton catheter is made behind the rectum. The Nelaton catheter loop is applied at the rectal wall parallel and caudal to the endolinear stapler and is pulled parallel the endolinear stapler toward the anterior side of the rectum. The endolinear stapler with opened jaws can be pushed deeper into the space, then the jaws can be closed in a position that can transect the rectum with one firing using only one cartridge.
Curative low anterior resection with rectal transection using the Nelaton catheter pulling method was performed in 13 patients with rectal cancer. The median value and range of tumor distance from the anal verge were 6.0 and 4.5 to 10.0 cm. The median duration of the operation was 284 minutes, and median blood loss was 10 mL. The number of stapling cartridges used for rectal transection was 1 in all cases, and there were no major complications.
We have demonstrated a safe, easy, and effective new transection method for rectal cancer resection using one firing with a Nelaton catheter.
腹腔镜低位前切除术加双吻合器技术治疗低位直肠癌具有一定难度，因为在狭窄的盆腔内进行直肠切断和吻合较为困难。
我们开发了一种使用少量钉仓进行直肠横断的新方法。在腹腔镜低位前切除术中，70mm 血管内夹夹闭肿瘤肛门侧的直肠壁。在直肠壁上平行于且低于 70mm 血管内夹应用直线型切割吻合器。将外径为 3.5 至 4.5mm 的尼纶导管插入，将尼纶导管的环置于直肠后方。将尼纶导管环应用于平行于且低于直线型切割吻合器的直肠壁上，并平行于直肠向其前侧牵拉。打开钳口的直线型切割吻合器可以更深地推入空间，然后可以在一个位置关闭钳口，使用一个钉仓即可完成直肠横断，只需一次击发。
13 例直肠癌患者采用尼纶导管牵拉法行根治性低位前切除术，肿瘤距肛门的中位值及范围为 6.0cm（4.5~10.0cm）。手术的中位时间为 284 分钟，中位出血量为 10ml。所有病例直肠横断均使用 1 个钉仓，无严重并发症。
我们已经证明了一种使用尼纶导管进行直肠切除的安全、简便、有效的新横断方法，只需一次击发。
