Total rectal excision
(removal of the rectum)
If a tumor is situated in the lower part of the colon (rectum) it is sometimes inevitable to remove the whole last part of the gut (red part in the drawing above). A stoma is then the consequence.
In this example a tumor was protruding from the anus. A biopsy showed a malignancy. There were no signs of metastases so it was decided to perform a total rectal excision. In 1 the protruding tumor can be seen, in 2 the line of incision is drawn and the future place of the stoma is pointed out. With an electrical knife the skin and the underlying tissues are opened (3).
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Whence the abdomen is opened, the part of the colon that is to be removed is freed together with the tissue containing the blood- and lymfvessels (4). For cleavage of the vessels here a special device is used (5,6:ligasure). The place of cleavage of the colon is determined in 7.
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Another special device that staples and cuts is used for cleavage of the colon (8,9,10). Then the colon is freed down into the small pelvis.
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An incision around the anus is made and with the same special device the rectum is freed from the surrounding tissues up into the small pelvis until the abdominal part is reached (11-14). Then the totally freed rectum can be removed (15)
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In 16 the removed specimen is shown, distally cut open, revealing the large tumor. Some details are shown in 17 and 18. In 19 the postoperative situation of the abdomen can be seen and in 20 the scar of the perineal wound is shown.
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