Laparoscopic assisted proctosigmoidectomy with extracorporeal transanal anastomosis

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Abstract
Laparoscopic colon resections have often required an abdominal incision to remove the specimen and perform the anastomosis. Our aim was to mobilize the left colon and rectum using the laparoscope and perform a perineal proctosigmoidectomy with a primary end-to-end anastomosis. In eight pigs we used the operating laparoscope to mobilize the left colon, to ligate the inferior mesenteric artery at its origin, to ligate the inferior mesenteric vein as it crossed the left colic artery, and to fully mobilize the rectum. The rectum and sigmoid colon were then prolapsed through the anal canal, transected, and anastomosis was performed using an EEA stapler. The anastomosis was tested for structural and vascular integrity. Following the procedure, laparotomy was performed to estimate blood loss, to record visceral injury, and to examine the specimen for extent of resection. We were able to perform the resection and anastomosis in all animals with minimal blood loss and with high ligation of the vascular pedicle. There were no major visceral injuries. All anastomoses were perfused, patent, and intact. We concluded that when using the laparoscope in the porcine model, a low anterior resection and anastomosis can be performed safely with an adequate specimen without a laparotomy incision.