Anterior Resection of the Rectum

Abstract

Single-port laparoscopic surgery (SPLS) for colorectal cancer is a recent development in minimally invasive surgery. Although the devices and techniques for SPLS are being improved year by year, some technical difficulties remain. In this chapter, we explain how to perform SPLS for sigmoid and rectal cancer. SPLS is usually applied to patients with a relatively small tumor (less than 4 cm) and without peritonitis carcinomatosa. A vertical incision (approximately 2.5 cm in length) is made. After insertion of an atraumatic wound retractor (Alexis™ (Applied Medical, Rancho Santa Margarita, CA, USA)), which remains in place throughout the procedure, a multi-access platform (MAP) is manually inserted into the incision. In most cases, standard straight laparoscopic instruments are used. All SPLS procedures are performed with surgical techniques similar to those used in our standard laparoscopic procedures. Left-sided anastomoses are performed intracorporeally with a circular stapler. We usually divide the colon or rectum using a flexible laparoscopic linear stapler inserted through the MAP. However, when it is technically difficult to divide the rectum at the lower level, we often use the prolapsing technique to cut the rectum more confidently.