Where is the best surgical incision for laparoscopic anterior resection?

Background/aims: For laparoscopic anterior resection, a small incision is placed in the left lower abdomen or suprapubic area, for which ideal location remains to be clarified. This study evaluated the validity of anthropometric placement of such an incision for colorectal anastomosis in laparoscopic anterior resection.

Methodology: Thirty consecutive patients with advanced rectal cancer (Age 30- 82 {mean 60.1} years, 15 men and 15 women) who underwent anterior resection by open surgery at Kashiwa Hospital between 2005 and 2006 were studied. The position of the viscera was projected on the anterior wall of the abdomen, in relation to the umbilicus.

Results: Each visceral position (X cm, Y cm) was as follows; SD junction (6.3 +/- 1.6, -2.0 +/- 2.3), promontorium (0.0 +/- 0.0, -4.5 +/- 0.8), Douglas' pouch (0.0 +/- 0.0, -14.9 +/- 1.5) and superior margin of the pubis (0.0 +/- 0.0, -18.2 +/- 1.4). The positions of promontorium and the Douglas' pouch had little horizontal anatomical variation and were located between the umbilicus and the pubis.

Conclusion: In laparoscopic anterior resection, a small incision for transection of the rectum and colorectal anastomosis should be placed in the suprapubic area rather than the left lower abdomen.