• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / Single Incision Laparoscopic Low Anterior Resection combined with Natural Orifice Surgery using prolapsing technique

Single Incision Laparoscopic Low Anterior Resection combined with Natural Orifice Surgery using prolapsing technique

Goutaro Katsuno, MD, PhD, Masaki Fukunaga, MD, PhD, Yoshifumi Lee, MD, PhD, Kunihiko Nagakari, MD, PhD, Masahiko Sugano, MD, PhD, Masaru Suda, MD, PhD, Yoshito Iida, MD, PhD, Seiichirou Yoshikawa, MD, PhD, Masakazu Ouchi, MD, PhD, Yoshitomo Itou, MD, PhD, Yoshinori Hirasaki, MD, PhD, Daisuke Azuma, MD, Shintaro Kohama, MD, Jun Nomoto, MD. Department of Surgery, Juntendo Urayasu Hospital, Juntendo University.

Introduction: It is often technically difficult to cut the lower rectum by endoscopic linear stapler in Single-incision Laparoscopic Low Anterior Resection (SILAR) because we need to insert some surgical devices through the same access platform. If we fail to cut the rectum correctly, it may cause anastomotic leakage.

Meanwhile, we have ever experienced 78 conventional laparoscopic low anterior resections using NOSE(Natural Orifice Specimen Extraction) with prolapsing technique for colo-rectal cancers. In these 78 cases, anastomotic leakage rate was very low (1/78: 1.28%). Using our experiences, we recently applied NOSE with prolapsing technique to overcome this technical difficulty in SILAR procedures for some selected patients.

Indications: SILAR is usually applied to cases that have relatively small tumor (less than 4cm) without peritonitis carcinomatosa. The patients with obesity (BMI >30) or extensive dilatation of the intestine are contraindicative for SILAR. Furthermore, the indications for prolapsing technique are as follows: (1) the extent of the primary tumor is below cT3; (2) tumor circumferential rate is below 50%; (3) anal stricture (-).

Surgical technique:

Single Incision Laparoscopic Low Anterior Resection (SILAR)
The access platform is placed in the small umbilical incision area. Recently, we usually use EZ accessTM as a Multi-access platform (MAP). SILAR is performed using a surgical technique similar to the conventional laparoscopic medial-to-lateral approach by standard straight laparoscopic instruments. We can usually divide the rectum using the flexible laparoscopic linear stapler inserted directly through the MAP. However, when we encounter some troubles where it might be technically difficult to divide the rectum at the lower level, NOSE (Natural Orifice Specimen Extraction) with prolapsing technique is very useful for dividing the rectum more confidently.

Natural Orifice Surgery using prolapsing technique
The proximal part of the tumor site is transected with laparoscopic staplers. Then, the tumor lesion and bowel are pulled out of the body through the anus by means of inversion, followed by cutting the distal side of the bowel with a stapler correctly and reinforcing the rectal stump by stich under direct vision. The distal side of the bowel is pushed back into the body. NOSE with prolapsing technique is complete. After that, the anvil is attached to the proximal part of the bowel at the umbilical incision site. Then, intra-corporeal anastomosis with Double Stapling Technique (DST) is performed.

Results: SILAR using NOSE with prolapsing technique was performed for 20 rectal cancer patients. All procedures were successful and were no anastomotic leakages in the series.

Conclusion: While the only drawback to this prolapsing technique is that it is limited to some selected patients, this technique enabled us to perform SILAR safely and reliably without spoiling the cosmetic advantage even in the cases where we needed to cut the lower rectum.

163

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals