title: Transanal single port access to facilitate distal rectal mobilization in laparoscopic rectal sleeve resection with hand-sewn coloanal anastomosis.
abstract: BACKGROUND
  Laparoscopic rectal sleeve resection is challenging and technically demanding. Exposure and mobilization of the most distal part of the rectum can be especially hazardous. We propose the use of a single port access device, placed in the anal canal after incision of the sleeve at the appropriate level, to facilitate dissection without sphincter damage. The case of a 51-year-old woman suffering from a recurrent supralevator abscess is presented to illustrate the technique.
  
  
  METHODS
  The procedure consisted of laparoscopic rectal pull-through with rectal sleeve resection and coloanal anastomosis. Incision of the endopelvic fascia and mobilization of the distal mesorectum was performed via the single port device under direct control. Medial-to-lateral mobilization of the colon was performed with a 3-port technique.
  
  
  RESULTS
  Total operating time was 122 min: 50 min for rectal mobilization, 42 min for the laparoscopic part of the procedure and 30 min for the coloanal anastomosis. The patient's recovery was uneventful, and at 1-month follow-up, she was asymptomatic.
  
  
  CONCLUSIONS
  Laparoscopic-assisted transanal single port rectal mobilization seems to be a promising addition to the armamentarium of minimally invasive surgery.
authors.affiliation: Department of Abdominal Surgery, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium. albert.wolthuis@uzleuven.be
authors.forename: A M
authors.initials: AM
authors.lastname: Wolthuis
authors.forename: C
authors.initials: C
authors.lastname: Cini
authors.forename: F
authors.initials: F
authors.lastname: Penninckx
authors.forename: A
authors.initials: A
authors.lastname: D'Hoore
mesh_terms: D018784:Abdominal Abscess / Q000601:surgery; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D012007:Rectum / Q000601:surgery*