Retrograde single stapling technique for laparoscopic ultralow anterior resection

Area of Science:

• Colorectal Surgery
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Laparoscopic ultralow anterior resection (ULAR) presents technical challenges, particularly achieving sufficient distal margins.
• Standard stapling techniques can be difficult in specific low rectal transection scenarios.

Purpose of the Study:

• To introduce and describe a novel retrograde single stapling technique (RSST) for laparoscopic ULAR.
• To provide a solution for challenging laparoscopic low rectal transections.

Main Methods:

• Laparoscopic total mesorectal excision followed by transanal tumor closure.
• Partial and circular rectal transection using laparoscopic coagulation shears (LCS).
• Extracorporeal resection, transanal anvil placement, and circular stapler anastomosis, with a balloon catheter for decompression.

Main Results:

• The retrograde single stapling technique (RSST) allows for effective laparoscopic low rectal transection.
• Successful end-to-end anastomosis was achieved using the described technique.
• A balloon catheter was utilized to decompress the anastomosis, aiming to prevent leakage.

Conclusions:

• The RSST is a viable and effective surgical technique for laparoscopic ULAR in challenging cases.
• This method addresses the technical difficulties associated with achieving adequate distal margins in low rectal surgery.
• The described approach facilitates safe and potentially lower-risk anastomosis in laparoscopic rectal resections.