Robotic low anterior resection for rectal cancer with side-to-end anastomosis in a patient with anal stenosis

Yosuke Tajima, Tsunekazu Hanai, Hidetoshi Katsuno, Koji Masumori, Yoshikazu Koide, Keigo Ashida, Hiroshi Matsuoka, Junichiro Hiro, Tomoyoshi Endo, Tadahiro Kamiya, Yongchol Chong, Kotaro Maeda, Ichiro Uyama

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1 Citation (Scopus)


Background: Colorectal anastomosis using the double stapling technique (DST) has become a standard procedure. However, DST is difficult to perform in patients with anal stenosis because a circular stapler cannot be inserted into the rectum through the anus. Thus, an alternative procedure is required for colorectal anastomosis. Case presentation: A 78-year-old woman presented with bloody stool. Colonoscopy and computed tomography revealed advanced low rectal cancer without lymph node or distant metastasis. We initially planned to perform low anterior resection using a double stapling technique or transanal hand-sewn anastomosis, but this would have been too difficult due to anal stenosis and fibrosis caused by a Milligan-Morgan hemorrhoidectomy performed 20 years earlier. The patient had never experienced defecation problems and declined a stoma. Therefore, we inserted an anvil into the rectal stump and fixed it robotically with a purse-string suture followed by insertion of the shaft of the circular stapler from the sigmoidal side. In this way, side-to-end anastomosis was accomplished laparoscopically. The distance from the anus to the anastomosis was 5 cm. The patient was discharged with no anastomotic leakage. Robotic assistance proved extremely useful for low anterior resection with side-to-end anastomosis. Conclusion: Performing side-to-end anastomosis with robotic assistance was extremely useful in this patient with rectal cancer and anal stenosis.

Original languageEnglish
Article number14
JournalWorld Journal of Surgical Oncology
Issue number1
Publication statusPublished - 12-2021

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology


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