TY - JOUR
AU - Marescaux, J
AB - Sir We agree that these results support the conventional approach, rather than the specific ‘laparoscopic assisted’ technique used by the authors. However, we doubt their results have implications for laparoscopic rectal cancer surgery in general. Data originated from a retrospective analysis of a small sample from two groups of patients in a previous randomized trial1, and this dilutes the significance of the result. Although dividing the inferior mesenteric artery using a stapler is uncommon in laparoscopic surgery for cancer and may put nerves plexuses at risk, we agree that the similar rates of impotence and ejaculatory problems, coupled with the low rate of bladder denervation, indicate that the lateral pelvic plexus deep in the pelvis was the most likely site of damage. However, completion of the rectal dissection in the pelvis was accomplished via a suprapubic incision (open approach), rather than by a totally intracorporeal technique, thus negating the benefits of improved laparoscopic visualization of structures deep in the pelvis2. It seems unjustified to conclude that the observed higher rate of nerve damage was attributed to the laparoscopic approach itself, as this was not used in the operative step where the injuries most likely occurred. We believe that such hybrid procedures should not be representative of the laparoscopic approach in randomized trials against conventional surgery as they dilute any potential advantage and may bias results when attributing specific risks to one or other approach. References 1 Tang CL , Eu KW, Tai BC, Soh JG, MacHin D, Seow-Choen F. Randomized clinical trial of the effect of open versus laparoscopically assisted colectomy on systemic immunity in patients with colorectal cancer . Br J Surg 2001 ; 88 : 801 – 807 . Google Scholar Crossref Search ADS PubMed WorldCat 2 Weiser MR , Milsom JW. Laparoscopic total mesorectal excision with autonomic nerve preservation . Semin Surg Oncol 2000 ; 19 : 396 – 403 . Google Scholar Crossref Search ADS PubMed WorldCat Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
TI - Bladder and sexual dysfunction following laparoscopically assisted and conventional open mesorectal resection for cancer (Br J Surg 2002; 89: 1551–1556)
JO - British Journal of Surgery
DO - 10.1002/bjs.4189
DA - 2003-03-31
UR - https://www.deepdyve.com/lp/oxford-university-press/bladder-and-sexual-dysfunction-following-laparoscopically-assisted-and-ofOFww5R6G
SP - 486
EP - 486
VL - 90
IS - 4
DP - DeepDyve
ER -