Low section of the rectum using the Contour™ device: An alternative technique

Abstract

We read with great interest the technical report on Low section of the rectum during laparoscopic total mesorectal excision using the Contour device by Targarona and coworkers, published in the February 2007 issue of Surgical Endoscopy. We do agree with the author regarding the important role that laparoscopy may play in the field of colorectal surgery for both benign and malignant diseases [1–3]. Rectal transection is undoubtedly a crucial step in rectal resections with total mesorectal excision and also during restorative proctocolectomy for familial adenomatous polyposis or ulcerative colitis. Available devices, as mentioned by Targarona, are not that effective for several reasons: their length, the impossibility of firing the device along an optimal line of transection due to the lack of articulation or the dimension of the stapler’s jaws and cartridge when working in a narrow pelvis, the need for multiple applications to accomplish the task, and sometime the need for a further cannula to overcome the difficulties in approaching the lower rectum from a right angle. A new stapler for closure-division of the lower rectum designed for open surgery (Contour, Ethicon) may be used even in laparoscopic surgery to perform safer low rectal transection and double-stapling anastomosis. Targarona describes the use of the Contour stapler through a hand-assisted device (LapDisc, Ethicon) and a 6cm-long Pfannenstiel incision after a five-port approach to laparoscopic rectal resection with total mesorectal excision (TME). In our early experience with the Contour stapler, we have used a different approach in three rectal resections with TME and three restorative proctocolectomies with Jpouch-anal canal double-stapling anastomosis, avoiding the use of rather expensive hand-assisted devices.