A Novel Laparoscopic Technique for Mesorectal Excision in Upper Rectal Cancer Using LigaSure Maryland Jaw

Background: Total mesorectal excision (TME) is crucial for preventing local recurrence of rectal cancer. However, TME is not always applicable in cases of upper rectal cancer, where mesorectal excision of 5 cm from the tumor towards the anal side is often sufficient. We developed a new laparoscopic procedure using the LigaSure™ Maryland Jaw to achieve adequate TME in upper rectal cancer. Operative Technique: After mobilizing the sigmoid colon, the inferior mesenteric vessels were ligated, and the mesorectum was dissected using the LigaSure™ along the planned excision layer. The rectal wall was separated from the mesorectum on the anal side of the tumor, transected with an endoscopic linear stapler, and the rectal stump was pulled towards the anal side to clearly identify the mesorectum. Results: This technique was successfully performed on 50 patients, achieving sufficient TME with accuracy and ease. Conclusion: This laparoscopic approach is a reliable and feasible method for performing adequate TME in upper rectal cancer cases.