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Minilaparoscopy-assisted transrectal low anterior resection (LAR): a preliminary study

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Abstract

Background

Natural orifice translumenal endoscopic surgery (NOTES) represents the evolution of surgery towards less invasive procedures. The feasibility of NOTES transrectal approach has increased its clinical applicability. This report describes a first series of minilaparoscopy-assisted transrectal low anterior resection with double purse-string end-to-end circular stapler anastomoses.

Methods

Between March and April 2012 three selected patients underwent transrectal minilaparoscopy-assisted natural orifice surgery total mesorectal excision for rectal cancer. All the oncologic principles of open/laparoscopic low anterior resection for rectal cancer were strictly fulfilled. Two patients underwent neoadjuvant treatment. Laparoscopic visualization and assistance was provided through one 10-mm umbilical port and two ports, one of which was used as stoma site (5 mm) and the other as a drain site (2 mm needle port). The specimen was transected transanally followed by the confection of double purse-string lateral/end-to-end anastomoses. There were no intraoperative complications.

Results

Mean operative time was 143 min. Oral intake was initiated on the second postoperative day. Patients were discharged home by day 5. The pathology unit confirmed that distal and circumferential margins were free of tumor invasion, and quality of mesorectum resection was reported satisfactory. One patient had to be readmitted because of severe dehydration due to increased ileostomy output. The patient was discharged at the third day after the readmission without renal failure.

Conclusions

In this preliminary report, transrectal minilaparoscopy-assisted low anterior resection was feasible and safe. Lateral/end-to-end anastomoses can be considered an interesting alternative to the double-stapling technique. However, it is necessary to further study and develop these procedures, along with careful patient selection, before transrectal low anterior resection may be considered for routine clinical use.

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Disclosures

Dr. Antonio M. Lacy is a consultant for Covidien and for Olympus Medical. Dr. Cedric Adelsdorfer and Dr. Salvadora Delgado have no conflicts of interest or financial ties to disclose. Dr. Patricia Sylla is a consultant for Genzyme and for educational activities for Applied Medical. Dr. David W. Rattner is a consultant for educational conferences for Olympus Medical.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases (ICMDM), Hospital Clínic, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Centro Esther Koplowitz, University of Barcelona, Barcelona, Spain

    Antonio M. Lacy, Cedric Adelsdorfer & Salvadora Delgado

  2. Division of Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA, USA

    Patricia Sylla & David W. Rattner

Authors
  1. Antonio M. Lacy
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  2. Cedric Adelsdorfer
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  3. Salvadora Delgado
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  4. Patricia Sylla
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  5. David W. Rattner
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Correspondence to Antonio M. Lacy.

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Lacy, A.M., Adelsdorfer, C., Delgado, S. et al. Minilaparoscopy-assisted transrectal low anterior resection (LAR): a preliminary study. Surg Endosc 27, 339–346 (2013). https://doi.org/10.1007/s00464-012-2443-9

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  • DOI: https://doi.org/10.1007/s00464-012-2443-9

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