title: Laparoscopic lower anterior rectal resection using a curved stapler: original technique and preliminary experience.
abstract: Laparoscopic low anterior rectal resection (LLAR), allowing better visualization and rectal mobilization, can reduce postoperative pain and recovery. A contour curved stapler (CCS) is a very helpful device because of its curved profile that consents better access into the pelvic cavity and allows to perform rectal closure and section in one shot, especially in the presence of a narrow pelvis, complex anatomy, or large tumors. We developed an original technique of laparoscopic rectal resection using CCS. Between 2005 and 2009, in 36 cases, we performed LLAR with a three-trocar technique, starting with mobilization of left colonic flexure followed by the section of inferior mesenteric vessels. The rectum was prepared up to the levator ani with total mesorectal excision. The Lapdisc was inserted trough a suprapubic midline incision, allowing the CCS stapler placement into the pelvic cavity. After the rectal section, the anastomosis was then performed with a circular stapler. Ileostomy was performed if neoadjuvant radiotherapy and chemotherapy have been carried out or if the anastomosis was below 4 cm from the anal verge. Mean operative time was 135 minutes and no intra- or postoperative bleeding occurred. In 27 patients we performed temporary ileostomy. In two cases we observed anastomotic leakage; one of these patients already had ileostomy. No anastomotic stenosis occurred after one-year follow-up. This procedure simplifies the section of the lower rectum, reduces leaking rate resulting from technical difficulties, and does not nullify the benefits of laparoscopy.
authors: Faculty of Medicine and Psychology, University Sapienza of Rome, St. Andreas Hospital of Rome, Rome, Italy.
authors: Antonio
authors: A
authors: Brescia
authors: Francesco Saverio
authors: FS
authors: Mari
authors: Francesco
authors: F
authors: Favi
authors: Andrea
authors: A
authors: Milillo
authors: Giuseppe
authors: G
authors: Nigri
authors: Anna
authors: A
authors: Dall'oglio
authors: Alessandra
authors: A
authors: Pancaldi
authors: Luigi
authors: L
authors: Masoni
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D003106:Colon / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies; D013528:Surgical Staplers; D013536:Suture Techniques / Q000295:instrumentation*