Full thickness recognition

Mathieu D’Hondt
Mohammed Abu Hilal

Using diathermy, the full thickness of the rectal wall is incised, starting at 5 or 7 o’clock. We avoid starting at 6 o’clock because the ano-coccygeal ligament makes it more difficult to find the correct initial plane. The full thickness rectotomy should be completed circumferentially by hooking onto the rectal wall when following the previously marked line of dissection. The dissection is done with a diathermic hook and an atraumatic grasper.

For a posterior dissection the diathermic hook is placed/positioned in an anteriorly located trocar. For an anterior dissection, it is placed in a posteriorly located port. This maximizes angulation and enables optimal dissection.

If the dissection is not performed full thickness from the beginning, the surgeon can get lost in the muscular layers of the bowel wall. This can lead to excessively deep dissection
in some locations, even causing perforation.

The effect of the pneumorectum is more efficient when the full thickness dissection is performed circumferentially because the specimen is already pushed inside a bit.

The recognition of the full thickness dissection is of crucial importance for every surgeon performing this procedure and feedback by an expert is mandatory in the beginning.