Reduced Port Laparoscopic TME with Low Colorectal Anastomosis
Recently, reduced port laparoscopic surgery (RPLS) including single-incision laparoscopic surgery (SILS) has been developed in many surgical procedures. However, rectal SILS is rare in colorectal lesions because of the difficulty to transect the lower rectum with sufficient distal margins from the umbilicus port with appropriate number of stapler firings. We have developed reduced port laparoscopic (SILS + 1 port) total mesenteric excision (TME) (RPLS-TME) in which we utilize the incision for pelvic drainage as an additional access route of the linear stapler at the transection of the lower rectum. A 2.5-cm transumbilical incision is made. A Lap protector is inserted through this incision, and the wound is protected. Next, an EZ-access is mounted, and three ports are placed. A 12-mm port is inserted in the right lower quadrant. All RPLS-TME procedures are performed with surgical techniques similar to those in our standard laparoscopic procedures. In this chapter, we explain how to perform our reduced port laparoscopic TME with low colorectal anastomosis for rectal cancer safely and reliably.
KeywordsReduced port laparoscopic surgery Total mesenteric excision Single-incision laparoscopic surgery Rectal cancer