Objective To estimate the improvement in surgical exposure by removal of the coccyx, during abdomino-perineal resection (APR), in rectal cancer patients. Methods Retrospective study of 29 consecutive patients with rectal cancer was carried out. Using MR T2 sagittal series, the solid angle was estimated using the angle determined by the anterior resection margin and the tip of coccyx (no coccyx resection) or the tip of last sacral vertebra (coccyx resection). The solid angle provides an estimate of the tridimensional surface area provided by an original angle resulting in the best estimate of the surgeon’s view/ex- posure to the critical dissecting point of choice (anterior rectal wall). The difference (‘‘Gain’’) in surgical ﬁeld exposure by removal of the coccyx was compared by the solid angle variation between the two estimates (with and without the coccyx). Results Routine removal of the coccyx determines an average 42% (95% CI 27–57%) gain in surgical ﬁeld exposure area facing the anterior rectal wall at the level of the prostate/vagina by the surgeon. Fifteen (51%) patients had C30% (median) estimated gain in surgical ﬁeld exposure by coccygectomy. There was no association between BMI, age or gender and estimated gain in surgical ﬁeld exposure area. Conclusions
World Journal of Surgery – Springer Journals
Published: May 30, 2018
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