title: Single-Incision Laparoscopic Anterior Resection Using a Curved Stapler.
abstract: BACKGROUND
  Single-incision laparoscopic colectomy is technically limited because of such factors as instrument crowding, in-line viewing, and insufficient countertraction. In particular, it is technically difficult to cut the distal rectum from the umbilicus using an articulating linear stapler in single-incision laparoscopic anterior resection.
  
  
  METHODS
  After treating the mesorectum, the 5-mm trocar is replaced with a 12-mm trocar. The cartridge of the curved stapler is mounted while the shaft of the stapler is inserted into the 12-mm port extracorporeally. The curved stapler is inserted through the umbilical incision with the cartridge. A multichannel port is then mounted, and the abdominal cavity is reinsufflated. The curved stapler can then be operated intracorporeally. This procedure facilitates the vertical dissection of the rectum from the umbilicus.
  
  
  RESULTS
  A total of 27 consecutive patients were analyzed in this study. All the procedures were safely performed without any complications. The median distance from the peritoneal reflection to the transection point of the distal bowel in single-incision laparoscopic anterior resection was 5.0 cm (range, -2.0 to 15.0). One stapler firing was required to achieve distal bowel division in 26 patients (96.3 %), whereas 2 firings were required in 1 patient (3.7 %). The median distal margin was 7.0 cm (range, 3.0-13.0). The time from the insertion of the stapler to transection was 180 seconds (range, 100-420). There were no cases of anastomotic leakage.
  
  
  CONCLUSIONS
  In single-incision laparoscopic anterior resection, it is feasible to perform rectal transection from the umbilicus by using a curved stapler. This technique may allow for the omission of 1 trocar from the operation.
authors.affiliation: 1 Department of Surgery, Yokosuka Kyosai Hospital, Yokosuka, Japan 2 Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan 3 Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Watanabe
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Ota
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Suwa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Ishibe
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Masui
authors.forename: Kaoru
authors.initials: K
authors.lastname: Nagahori
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D057868:Anastomotic Leak / Q000517:prevention & control*; D003082:Colectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007564:Japan; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D013528:Surgical Staplers; D016896:Treatment Outcome