Abstract
Background
Rectal transection and anastomosis at the lower rectum is the most challenging part of laparoscopic low anterior resection. Therefore, some have demonstrated that rectal transection should be performed using instruments for open surgery with small laparotomy. In our institute, however, rectal transection using a currently available endostapler followed by anastomosis with a double stapling technique is usually performed.
Methods
The important points of our technique are as follows: trocar placement, optimal device choice, harmonious movement between the operator and assistant for rectal transection, optimal point of piercing with the center rod of the circular stapler, and ideal positioning of the proximal colon.
Results
Seventy-eight patients underwent low anterior resection using this technique. There were no conversions to open surgery. All rectal transections were completed laparoscopically with an available endostapler. A diverting ileostomy was created in six cases. Anastomotic leakage occurred in only two patients (2.6%) and rectovaginal fistula in only one patient (1.3%).
Conclusions
Our standardized technique is considered to be safe and feasible for rectal transection and anastomosis using the double stapling technique (DST).
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References
Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726
Ueno M, Oya M, Azekura K, Yamaguchi T, Muto T (2005) Incidence and prognostic significance of lateral lymph node metastasis in patients with advanced low rectal cancer. Br J Surg, 92:756–763
Fukunaga Y, Higashino M, Tanimura S, Nishiguchi Y, Kishida S, Nishikawa M, Ogata A, Osugi H (2003) A novel laparoscopic technique for stapled colon and rectal anastomosis. Tech Coloproctol 7:192–197
Ishii Y, Hasegawa H, Nishibori H, Endo T, Kitajima M (2006) The application of a new stapling device for open surgery (Contour Curved Cutter Stapler) in the laparoscopic resection of rectal cancer. Surg Endosc 20:1329–1331
Ichihara T, Nagahata Y, Nomura H, Fukumoto S, Urakawa T, Aoyama N, Kuroda Y (2000) Laparoscopic lower anterior resection is equivalent to laparotomy for lower rectal cancer at the distal line of resection. Am J Surg 179:9–98
Law WL, Chu KW, Tung HM (2004) Early outcomes of 100 patients with laparoscopic resection for rectal neoplasm. Surg Endosc 18:1592–1596
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Kuroyanagi, H., Oya, M., Ueno, M. et al. Standardized technique of laparoscopic intracorporeal rectal transection and anastomosis for low anterior resection. Surg Endosc 22, 557–561 (2008). https://doi.org/10.1007/s00464-007-9626-9
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DOI: https://doi.org/10.1007/s00464-007-9626-9