title: Totally laparoscopic low anterior resection for lower rectal cancer: combination of a new technique for intracorporeal anastomosis with prolapsing technique.
abstract: BACKGROUND
  Laparoscopically assisted low anterior resection is difficult even for experienced surgeons because of difficulties in selecting the appropriate transection line and completing anastomosis in the narrow pelvic space. The prolapsing technique resolves these problems. We combined our new technique for intracorporeal anastomosis with this prolapsing technique and achieved a totally laparoscopic low anterior resection.
  
  
  METHODS
  After the total mesorectal excision, a semi-circumferential colotomy is made at the anterior colonic wall just proximal to the proximal transection site. The anvil of a circular stapling device, secured with a Prolene suture, is introduced via the colotomy. The suture is advanced anteriorly so that the center rod of the anvil penetrates the colonic wall. The colon is staple-transected at this point to secure the anvil on the proximal colon. The distal rectum is everted and pulled transanally outside the body using a grasping forceps inserted from the anus. Staple-closure and transection of the distal rectum is performed under direct vision. Anastomosis is established using the double-stapling technique.
  
  
  RESULTS
  Totally laparoscopic low anterior resections using this technique were performed for 7 patients with rectal cancer. There was no anastomotic leakage/stenosis.
  
  
  CONCLUSIONS
  Our procedure can be performed easily, which enables surgeons to achieve minimal invasiveness compared with hybrid NOTES.
authors.affiliation: Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, Japan. h.akamatsu@me.com
authors.forename: Hiroki
authors.initials: H
authors.lastname: Akamatsu
authors.forename: Takeshi
authors.initials: T
authors.lastname: Omori
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Oyama
authors.forename: Masayuki
authors.initials: M
authors.lastname: Tori
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Ueshima
authors.forename: Toshirou
authors.initials: T
authors.lastname: Nishida
authors.forename: Masaaki
authors.initials: M
authors.lastname: Nakahara
authors.forename: Takashi
authors.initials: T
authors.lastname: Abe
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D003082:Colectomy / Q000295:instrumentation / Q000379:methods*; D013505:Digestive System Surgical Procedures / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome