A safe and feasible technique: laparoscopic manual binding technique for intracorporeal anastomosis in totally laparoscopic anterior resection of high-mid rectal cancer

Abstract

Background Totally laparoscopic anterior resection (TLAC) is difficult even for experienced surgeons because of difficulties in fixating the anvil of circular stapling device with laparoscopy. We herein report a novel technique of laparoscopic manual binding technique (MBT) to conduct intracorporeal anastomosis by the double-stapling technique (DST) for high-mid rectal cancer. Methods Since April 2019, MBT for intracorporeal anastomosis in TLAC were performed for 12 patients. After the total mesorectal excision, the anvil of a circular stapling device is put in the abdominal cavity through the anus and inserted into the proximal colonic stump. At the pre-anastomotic site, the intestinal wall of colon is fully fixated on the central rod of the anvil with surgical suture No. 0 by manual binding with laparoscopic instruments as laparoscopic grasping forceps, in addition, double binding if necessary. Then, the end of the colon and rectum is anastomosised by the double-stapling technique (DST). Results A total of 12 patients completed the operation successfully. Only one patient experienced fever (T < 38.5 °C) after operation. No patients experienced surgical complications greater than Clavien–Dindo grade I. Conclusions We introduced the usefulness of the MBT to improve TLAC. MBT for intracorporeal anastomosis in TLAC for high-mid rectal cancer is safe and feasible.