Simultaneous laparoscopic abdominal and transanal excision for low rectal tumours

Aim:  In performing laparoscopic sphincter-preserving total mesorectal excision, one of the technical challenges is to obtain an adequate distal mural margin of 2 cm in the case of low rectal tumours. Herein we describe a technique, known as simultaneous laparoscopic abdominal and transanal excision, where an adequate distal margin can be safely achieved at the beginning of the operation. Methods and Results:  As the specimen is delivered per anum, the patient can enjoy the full benefits of minimally invasive surgery. Additionally, the simultaneous approach helps to shorten the operating time. The technique was attempted in five patients with radiological T2 or T3 disease, with two patients having received neoadjuvant chemoirradiation. The outcomes of these five patients are presented. Conclusion:  As treatment of rectal cancer is increasingly stage dependent, the simultaneous laparoscopic abdominal and transanal excision procedure offers a clear alternative for treating patients with low rectal tumours in this laparoscopic era.