title: Intracorporeal rectal stapling following laparoscopic total mesorectal excision: overcoming a challenge.
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 degrees 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 degrees and 68 degrees .
  
  
  CONCLUSIONS
  A roticulating stapler with minimum angulation of 65 degrees would achieve transverse division of the rectum following laparoscopic TME.
authors.affiliation: Department of Abdominal Surgery, University Clinics Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium.
authors.forename: A E
authors.initials: AE
authors.lastname: Brannigan
authors.forename: S
authors.initials: S
authors.lastname: De Buck
authors.forename: P
authors.initials: P
authors.lastname: Suetens
authors.forename: F
authors.initials: F
authors.lastname: Penninckx
authors.forename: A
authors.initials: A
authors.lastname: D'Hoore
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D010535:Laparoscopy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000473:pathology; D012004:Rectal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014584:User-Computer Interface