[Background] Even in the up to date laparoscopic colorectal surgery, transection and anastomosis of the rectum in the narrow pelvic cavity might be challenging. In this study, we compared three methods to find out the best way to do safe and effective laparoscopic surgery for rectal cancer.
[Patients and methods] Between April 1993 and August 2007, we operated laparoscopically ninety-five patients of rectal cancer. Seventeen patients converted to open surgery were excluded from this study. Two colorectal surgeons performed all operations, and all anastomosis were done in DST fashion. During this period, we tried following three methods; A) Transection using staplers designed for open surgery (Access55) under the direct vision from small mid-line incision (8 cases), B) Transection using staplers designed for laparoscopic surgery (ex. Endo-GIA or Endocutter) (49 cases), C) Transection using staplers designed for open surgery (ex. TX30G or TA45) inserted through Lap disk (Hakko, Inc. Tokyo Japan), which was abdominal wall sealing device attached to 5 cm pfannenstiel incision (21 cases).
[Results] There was no significant difference in age, gender and operative time between the three groups. We encountered no anastomotic leakage in group A and C, but seven cases in group B (14.3%) were suffered from this major complication. In group B, however, no leakage was seen if we used so-called “slow stapling technique”. The length of hospital stay was the shortest in group C. The advantage of method C seems to be the point that all procedures could be done under the magnified view of the laparoscope maintaining pneumoperitoneum.
[Conclusion] At this moment, method C might provide secure and uniform transection and anastomosis in the laparoscope-assisted surgery for rectal cancer.
Program Number: P096