title: Can a curved stapler made for open surgery be useful in laparoscopic lower rectal resections? Technique and experience of a single centre.
abstract: BACKGROUND
  The use of laparoscopy to perform lower anterior rectal resection is increasing worldwide because it allows better visualisation and rectal mobilisation and also reduces postoperative pain and recovery. The Contour Curved Stapler (CCS) is a very helpful device because of its curved profile that enables better access into the pelvic cavity and allows rectal closure and section to be performed in one shot. In this paper, we present an original technique to use this device, made for open surgery, in laparoscopy and the results of our experience.
  
  
  METHODS
  We retrospectively evaluated the data of all patients who underwent lower laparoscopic anterior rectal resection and in which the CCS was used to perform section of the rectum between September 2005 and September 2011. To perform section of the rectum a Lapdisc(®) was inserted through a 6-7 cm supra-pubic midline incision to allow placement of the CCS into the pelvic cavity. Patients' biographical and surgical data such as sex, age, indication for surgery, infection, anastomotic leakage or stenosis and staple-line bleeding were prospectively collected in a computerised database and evaluated.
  
  
  RESULTS
  Between September 2005 and September 2011, we performed 45 laparoscopic lower rectal resection using CCS, 27 male and 18 female with a mean age of 61 years (range 40-82 years) and a mean body mass index (BMI) of 26.5 kg/m(2) (range 16.5-35 kg/m(2)). In 29 cases a temporary ileostomy was performed. Mean operative time was 131 min (range 97-210 min). In all cases it was possible to perform a lower section of the rectum with CCS. No intraoperative or postoperative staple line bleeding occurred. In two patients we observed anastomotic leaks and in one of these a temporary ileostomy was performed. None of the patients showed an anastomotic stenosis at 1-year follow-up colonoscopy.
  
  
  CONCLUSIONS
  This study shows that CCS enables section of the lower rectum to be easily performed, especially in adverse anatomical condition, and the technique proposed by us allows the use of this stapler without giving up the benefits of laparoscopic access.
authors.affiliation: Department of Surgery, St. Andrea Hospital, School of Medicine and Psychology, University Sapienza of Rome, Rome, Italy. frasavmari@yahoo.it
authors.forename: Francesco Saverio
authors.initials: FS
authors.lastname: Mari
authors.forename: Marcello
authors.initials: M
authors.lastname: Gasparrini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nigri
authors.forename: Giammauro
authors.initials: G
authors.lastname: Berardi
authors.forename: Giovanni Guglielmo
authors.initials: GG
authors.lastname: Laracca
authors.forename: Barbara
authors.initials: B
authors.lastname: Flora
authors.forename: Alessandra
authors.initials: A
authors.lastname: Pancaldi
authors.forename: Antonio
authors.initials: A
authors.lastname: Brescia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000295:instrumentation*; D013537:Sutures; D016896:Treatment Outcome