An E type anal retractor which was connected to an Octopus retractor holder was utilized for anal local excision to obtain an excellent field of surgery. Anastomoses were performed using the automatic suture clamp to avoid possible bacterial contamination and to expedite anastomoses. This technique was performed in 6 cases of early rectal cancer (7 lesions) and 4 cases of sessile adenoma. Five of 10 cases were asymtomatic. The mean maximum diameter of the rectal tumors was 24 (10-35) mm. Tumors were located above the peritoneal reflection in 6 of 11 lesions. The mean distance from the anal verge to the distal margin of the tumor was 9.5 (5-15) cm. The mean operating time and blood loss were 24 (7-31) minutes and 16.8 (0-60) g respectively. Histological examination revealed complete excision of the tumors in all cases. Additional colectomy was performed in 2 cases due to possible lymph node spread. No mortality and postoperative complications were observed with the exception of one case of transient bleeding. This technique was considered to be a minimally invasive surgery which enabled us to obtain an excellent surgical field and an approach to a tumor above the peritoneal reflection.
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