Laparoscopic Anterior Resection for Colorectal Cancer Without Minilaparotomy Using Transanal Bowel Reversing Retrieval

Abstract

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. 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. 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. 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.