Reduced port laparoscopic TME with coloanal anastomosis

We began performing a single-incision plus one additional port laparoscopyassisted anterior resection of the rectum (SILS+1-AR) in August 2010. In recent years, intersphincteric resection (ISR) is proposed as a means of offering sphincter preservation in patients with very low rectal cancer and has become an accepted surgical procedure. Moreover, the procedure of ultralow anterior resection mainly includes an ISR for sphincter-saving operation. Therefore, we applied SILS+1 partial ISR in cases of rectal cancer located within 5 cm from the anal verge. In the SILS+1-AR without ISR, a 3-cm trans-umbilical incision was made, and the SILS™ port was inserted, and an additional 12-mm trocar was placed in the right lower quadrant. In the SILS+1 partial ISR, a SILS™ port was placed in the right lower quadrant at the intended ileostomy site, and a 5-mm trocar was inserted at the umbilicus at the subsequent drain site. The surgical procedure of partial ISR included five stages: colonic mobilization, pelvic dissection with total mesorectal excision (TME), transabdominal dissection of the intersphincteric space, stapled coloanal anastomosis, and diverting stoma. All postoperative outcomes were satisfactory (data not shown). Reduced port laparoscopic TME for rectal carcinoma with or without ISR can be performed safely, and its feasibility depends on proper selection of patients.