title: Laparoscopic anterior resection for colorectal cancer without minilaparotomy using transanal bowel reversing retrieval.
abstract: OBJECTIVE
  In laparoscopic colon resection for rectosigmoid colon cancer, minilaparotomy is usually necessary for specimen retrieval and completion of primary anastomosis. This incision may increase postoperative pain, and cause wound infection or other complications. We describe a new technique of laparoscopic anterior colon resection without requiring a minilaparotomy incision.
  
  
  METHODS
  We attempted this procedure on 9 patients with sigmoid colon or rectal cancer. We ligated the inferior mesenteric artery and divided the bowel proximally, similar to conventional laparoscopic technique. We pulled out the specimen and the rectum transanally, and performed distal colon division extracorporeally. An anvil was inserted transanally into corporeal cavity and then, inserted into the proximal stump of the colon lumen laparoscopically. We placed a purse-string suture extracorporeally around the distal colon stump, and then completed a side-to-end anastomosis intracorporeally.
  
  
  RESULTS
  The procedure was successfully completed in 8 of the 9 patients. Median operative time was 293 minutes and median blood loss was 47.2 mL. No major complications were observed.
  
  
  CONCLUSIONS
  This novel technique of transanal specimen retrieval and intracorporeal anastomosis with extracorporeal purse-string placement can be performed safely and easily in patients with rectosigmoid colon cancer.
authors: Department of Gastroenterological Surgery, Nagoya City University, Nagoya, Japan. mshara@med.nagoya-cu.ac.jp
authors: Masayasu
authors: M
authors: Hara
authors: Satoru
authors: S
authors: Takayama
authors: Mikinori
authors: M
authors: Sato
authors: Hiroyuki
authors: H
authors: Imafuji
authors: Hiroki
authors: H
authors: Takahashi
authors: Hiromitsu
authors: H
authors: Takeyama
mesh_terms: D000368:Aged; D001003:Anal Canal; D000818:Animals; D003082:Colectomy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D000075202:Contraindications; D004195:Disease Models, Animal; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control; D013552:Swine; D013997:Time Factors; D016896:Treatment Outcome