Quality of surgery for rectal cancer may be influenced by several more or less technical aspects. We know for example two different kinds of obesity. Some patients have a very thick subcutaneous layer, but inside the peritoneal cavity we see no fatty tissue. Others may have a thick mesentery or fatty appendices epiploicae, all leading to difficulties in anatomical orientation or operation field adjustment problems during surgery. Sometimes important anatomical structures may be non-visible and/or non-palpable. Furthermore, tissue consistency in elderly patients might be very friable, thus creating a surgical challenge.
It should also be mentioned that technical equipment (Ultracision®, Ligasure®), including a good light source (e.g. head set, rectal hook with light source) and a devoted assistant during the operation help to make the operation easier.
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