Laparoscopic bowel-lifting technique: a novel and standardized technique for laparoscopic low anterior resection for...

Although surgeons have tried to reduce the number of ports in order to achieve better cosmesis and less postoperative pain, it may lead to increased risk for complications. Herein, we introduce a technique, "laparoscopic bowel-lifting (LBL) technique," which helps to reduce ports without additional trocars.

The mesocolon is pierced near the line of transaction using the pair of dissecting forceps. A 1-0 Vicryl suture is introduced into the abdominal cavity using a grasping needle and passed through the mesocolon. The colon is retracted using the suture and fixed to the abdominal wall using a pair of forceps. Thereafter, traction is placed on the main nutrient artery. Mobilization of the rectum is performed after moving the traction to the cranial side by using a grasping needle. As the rectal tube was pulled toward the cranial side, it is possible to identify the mesorectum with a good visual field.

We performed this procedure in 100 consecutive patients with rectal cancer who underwent curative laparoscopic low anterior resection (Lap-LAR) between November 2001 and March 2010. The median duration of follow-up after Lap-LAR was 53.2 months. The tumor was located in the middle rectum in 75 patients and in the lower rectum in 25 patients. The stage grouping on the basis of the TNM classification was as follows: stage 0, 6; stage I, 46; stage II, 18; and stage III, 30. The number of trocars used in the LBL group was 3 or 4. No LBL cases used 5 trocars. No operative complications were attributable to this technique. The overall rates of anastomotic leakage and morbidity were 10.0% and 33.0%, respectively. The 5-year relapse-free and 5-year overall survival rates were stage 0, 100/100; stage I, 93.3/96.8; stage II, 81.5/88.5; and stage III, 74.5/75.7.

LBL technique is feasible for performing Lap-LAR. This method reduces the number of ports and might help to introduce a single-incisional surgery.