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Laparoscopic Low Anterior Resection with Distal Rectal Washout Using the New Device of Gut-clamper
World Journal of Laparoscopic Surgery, September-December 2008;1(3):31-34
Laparoscopic Low Anterior Resection with

Distal Rectal Washout Using the New Device of

Gut-clamper

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1 Takao Ichihara, Moriatsu Takada, Yoshikazu Kuroda
2,3
1 Department of Surgery, Nishinomiya Municipal Central Hospital, Nishinomiya, Hyogo, Japan
2 Kobe Research Institute for Medical Sciences, Kobe, Japan
3 Takada Medical and Surgical Clinic, Kobe, Japan
4 Department of Gastroenterological Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan

Correspondence: Moriatsu Takada, 2-1-4, Minamigoyo, Kita-ku, Kobe 651-1132, Japan
Tel: +81-78-904-8500; Fax: +81-78-904-8518; E-mail: moriatsu@kobe-u.com

4-8
Abstract controlled trials to support its use. Although some authors
have recommended no preparation, an empty colon is generally
Background: Intraoperative rectal washout is considered to be important
in colorectal surgery, but it is rather difficult in laparoscopic surgery. considered to facilitate manipulation of the bowel during
To resolve the problem, a new device called gut-clamper have invented laparoscopic colon and rectal surgery. It has been reported that
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for complete washout of the rectum during the laparoscopic low occlusion of the rectum allow for distal rectal washout. It
anterior resection. eliminates clamp slippage and faecal spillage and improves
access to the distal rectum for low anastomosis.
Methods: Forty patients with rectal cancer underwent laparoscopic
low anterior resection by a single skilled operator. When considering a completely laparoscopic approach with
intracorporeal anastomosis, a complete reduction of the risk of
Results: Thirty patients with rectal cancer underwent laparoscopic postoperative leakage might be a major issue for the laparoscopic
low anterior resection with colorectal washout using gut-clamper. There surgeons.
was one complication of leakage in ten cases underwent without using
gut-clamper. The number of times using laparoscopic staplers was In colorectal surgery, it is required a sufficient space neces-
1.9±1.0 in the cases using gut-clamper, while that was 3.4 ± 1.1 in the sary for using instruments. Besides, it is rather difficult to secure
cases without using gut-clamper. the space in laparoscopic surgery. Under such circumstances,
only a few laparoscopic surgeons have been performed intra-
Conclusion: This device of gut-clamper is easy and safe as well as operative distal rectal washout.
reasonable physically and economically for intra-operative rectal
washout including laparoscopic colorectal resection. In order to resolve the problem, we have invented a new
device called gut-clamper for easy and complete washout of
Keywords: Laparoscopic low anterior resection; rectal washout; gut- the rectum in the laparoscopic low anterior resection. Here, we
clamper. describe the new technique using this device and discuss its
clinical outcomes.
INTRODUCTION
Intraoperative rectal washout is considered to be important in PATIENTS AND METHODS
colorectal surgery, because implantation of exfoliated malignant Patients
cells is suggested as a possible mechanism of tumor recurrence
in colorectal anastomosis that might be prevented by cytocidal From April 2004 through December 2007, thirty patients (13
washout. It is widely believed that the practice of distal rectal men and 17 women) with rectal cancer underwent laparoscopic
washout before anastomosis prevents implantation of free low anterior resection in Nishinomiya Municipal Central
malignant cells followed by reducing the incidence of local Hospital, Kobe University Hospital and it affiliates by a single
recurrence. 1-3 skilled operator. Median patients age was 71.4 years (range
Standard guidelines are published regarding the effective- 66-87). To investigate the effectiveness of gut-clamper, the
ness of preoperative colorectal washout. Preoperative mecha- patients with rectal cancer underwent laparoscopic low anterior
nical bowel preparation is the common practice, despite lack of resection with colorectal washout, with or without using gut-
clear evidence of benefit from meta-analysis and randomized clamper.

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