Abstract
Background
Division of the rectum following total mesorectal excision (TME) using intracorporeal stapling devices is technically difficult due to their width and limited roticulation. More than one cartridge is often required and resultant wedging of the stump may be associated with an appreciable leak rate.
Methods
Three-dimensional reconstruction was performed of CT and MRI images from the lower abdomen of six patients undergoing laparoscopic TME using the Amira software environment. The stapling device was virtually reconstructed by in-house developed software, superimposed over the point of division of the rectum and the site of skin entry identified.
Results
The 45° angulation of available roticulating stapling devices precludes perpendicular division of the rectum following laparoscopic TME. The optimal angulation for transverse rectal stapling varied between 62° and 68°.
Conclusion
A roticulating stapler with minimum angulation of 65° would achieve transverse division of the rectum following laparoscopic TME.
Similar content being viewed by others
References
Bakx R, Busch OR, Bemelman WA, Veldink GJ, Slors JF, van Lanschot JJ (2004) Morbidity of temporary loop ileostomies. Dig Surg 21: 277–281
Bemelman WA, D’Hoore A (2005) Laparoscopic restorative proctocolectomy (Br J Surg 2005; 92: 88–93) [Letter]. Br J Surg 92: 493
Bretagnol F, Rullier E, Couderc P, Rullier A, Sairc J (2003) Technical and oncological feasibility of laparoscopic total mesorectal excision with pouch coloanal anastomosis for rectal cancer. Colorectal Dis 5: 451–453
Delgado S, Momblán D, Salvador L, Bravo R, Castells A, Ibarzabal A, Piqué JM, Lacy AM (2004) Laparoscopic-assisted approach in rectal cancer patients; lessons learned from > 200 patients. Surg Endosc 18: 1457–1462
Morino M, Parinin U, Giraudo G, Salval M, Brachet Contul R, Garrone C (2003) Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg 237: 335–342
Rivadeneira DE, Marcello PW, Roberts PL, Rusin LC, Murray JJ, Coller JA, Schoetz DJ Jr (2004) Benefits of hand-assisted laparoscopic restorative proctocolectomy: a comparative study. Dis Colon Rectum 47: 1371–1376
Tsang WWC, Chung CC, Kwok SY, Li MKW (2005) Minimally invasive surgery for rectal cancer. Surg Clin North Am 85: 61–73
Vithiananthan S, Cooper Z, Betten K, Stapleton GS, Carter J, Huang EH, Whelan RL (2001) Hybrid laparoscopic flexure takedown and open procedure for rectal resection is associated with significantly shorter length of stay than equivalent open resection. Dis Colon Rectum 44: 927–935
Wong KS, Remzi FH, Gorgun E, Arrigain S, Church JM, Preen M, Fazio VW (2005) Loop ileostomy closure after restorative proctocolectomy: outcome in 1,504 patients. Dis Colon Rectum 48: 243–250
Yamamoto S, Fujita S, Akasu T, Moriya Y (2004) A comparison of the complication rates between laparoscopic colectomy and laparoscopic low anterior resection. Surg Endosc 18: 1447–1451
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Brannigan, A.E., De Buck, S., Suetens, P. et al. Intracorporeal rectal stapling following laparoscopic total mesorectal excision. Surg Endosc 20, 952–955 (2006). https://doi.org/10.1007/s00464-005-0536-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-005-0536-4