CEEA-29 device

Laparoscopic obstructive anterior resection of rectum with the formation of temporary terminal sigmostoma with the further reconstructive-restorative operation with formation of colorectal anastomosis

Laparoscopic obstructive anterior resection of rectum with the formation of temporary terminal sigmostoma with the further reconstructive-restorative operation with formation of colorectal anastomosis
Professor Puchkov K.V. is performing an operation (2016).

A 65 year-old female patient was treated, having the diagnosis: Cancer of the upper third of rectum fT4N0M0. She was admitted to hospital with subcompensated tumourous stenosis of the large colon, microcytic hypochromic anemia (Hb-79g/L), tumourous intoxication, cachexia. During preoperation investigation of abdominal cavity organs due to RCT the single increased up to 1.0 cm lymphatic node along the superior rectal artery has been found out. The “classical” scheme of positioning of trocars was used: in the right and left iliac area, and to the left in the mesogastric area. The operation was started with dissection of peritoneum to the right of rectum, exposure of rectum along the posterior wall with the identification of the left ureter. Transection of the inferior mesenteric artery was done near the origin with applying two titanic clips. The next stage was dissection of peritoneum of the left lateral canal and mobilization of the descending part of the colon. Exposure of rectum was done in 5 cm lower than distal border of tumour along the posterior wall, then along the right and left semicircumference, and only then-along the anterior wall. Transection of the large colon in its distal part was done with EndoGIA-45 (green and blue reload) device («MEDTRONIC COVIDIEN»). Removal of specimen was done by performing a minilaparotomy. In the left mesogastric area sigmostoma was created. The operation was finished by placing drainage transabdominally via a trocar wound in the right iliac area. Operation time was 115 minutes. After a radical operation, a specimen was sent for histological investigation. Histological conclusion was: highly and moderately differentiated adenocarcinoma of rectum with invasion to the muscle layer of the large colon (without invading to the serous membrane), with invasion to the muscle layer of the loop of the sigmoid colon (without invading to the mucous membrane). In lymphatic nodes, there were no symptoms of tumour growth. Molecular-genetic investigations (NRAS, BRAF, KRAS): the symptoms of mutations had not been found out. A chemotherapeutic specialist had consulted her and recommended to have adjuvant polychemotherapy according to XELOX scheme (oxalaplatin+xelode). The patient had 8 courses of chemotherapy.
In 10 months after resection of the primary tumour reconstructive-restorative operation was performed for restoration of intestinal continuity with the formation of colorectal anastomosis, creation of temporary ileostoma. The “classical” scheme of positioning of trocars was used: in the right and left iliac area, and to the left of mesogastric area. The operation was started with stitching stoma on the anterior abdominal wall, exposure out of tissues of the anterior abdominal wall. CEEA-29 («Medtronic-Covidien») device head was inserted into the proximal part and fixed by purse-string suture, using “Vicryl” 2-0 thread, was immersed into the abdominal cavity. Then adhesyolisis was performed; exposure of descending colon along the left lateral canal with 5 mm LigaSure («Medtronic-Covidien») device took place. The mandatory condition of successful performing an operation by laparoscopic approach is separation of all possible adhesions between colon and surrounding tissues, dissection of abdomen along the posterior
semicircumference with the identification of the left ureter. After handling of the proximal part of the colon the stump of rectum was exposed with a monopolar “hook” electrode. CEEA-29 device was introduced transanally, adjustment of the head and apparatus was done, then stitching and removal of the device. At the end of operation single interrupted suture was placed between the proximal and distal parts of anastomosis. Operation was finished by placing drainage transabdominally through a trocar wound in the right iliac area, creation a temporary loop ileostoma in the right iliac area. Operation time was 120 minutes. In 3 months a new operation was performed for intraabdominal closure of ileostoma.

You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.