title: Where is the best surgical incision for laparoscopic anterior resection?
abstract: OBJECTIVE
  For laparoscopic anterior resection, a small incision is placed in the left lower abdomen or suprapubic area, for which ideal location remains to be clarified. This study evaluated the validity of anthropometric placement of such an incision for colorectal anastomosis in laparoscopic anterior resection.
  
  
  METHODS
  Thirty consecutive patients with advanced rectal cancer (Age 30- 82 {mean 60.1} years, 15 men and 15 women) who underwent anterior resection by open surgery at Kashiwa Hospital between 2005 and 2006 were studied. The position of the viscera was projected on the anterior wall of the abdomen, in relation to the umbilicus.
  
  
  RESULTS
  Each visceral position (X cm, Y cm) was as follows; SD junction (6.3 +/- 1.6, -2.0 +/- 2.3), promontorium (0.0 +/- 0.0, -4.5 +/- 0.8), Douglas' pouch (0.0 +/- 0.0, -14.9 +/- 1.5) and superior margin of the pubis (0.0 +/- 0.0, -18.2 +/- 1.4). The positions of promontorium and the Douglas' pouch had little horizontal anatomical variation and were located between the umbilicus and the pubis.
  
  
  CONCLUSIONS
  In laparoscopic anterior resection, a small incision for transection of the rectum and colorectal anastomosis should be placed in the suprapubic area rather than the left lower abdomen.
authors.affiliation: Department of Surgery, Jikei University School of Medicine, Nishi-Shinbashi 3-25-8, Minato-ku, Tokyo 105-8461, Japan. kawahide@jikei.ac.jp
authors.forename: Hidejiro
authors.initials: H
authors.lastname: Kawahara
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Watanabe
authors.forename: Susumu
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kashiwagi
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods*; D004312:Douglas' Pouch / Q000033:anatomy & histology; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D014472:Umbilicus / Q000033:anatomy & histology