Single-access laparoscopic rectal resection: up-to-down and down-to-up

Single-access laparoscopy (SAL) took interest in the last decade, due to the attraction to perform minimally invasive surgery (MIS) through the natural orifices, adding enhanced cosmetic outcomes to the general benefits of MIS. SAL for rectal resection has been de-scribed as feasible and safe. Obviously the patients’ selection and the surgeon’s skills are mandatory. Recently, the application of transanal laparoscopy to the surgery of the rectum gained popularity as well. The union between the abdominal SAL and the transanal total mesorectal excision (TaTME) makes sense because the vascular dissection and the colic mobilization can be performed through the SAL, the TME can be realized through the transanal route, and the abdominal access-site can be used for the temporary ileostomy placement at the end of the procedure. In this chapter, the rectal resection with TME through abdominal SAL or abdominal SAL plus TaTME, is described in details.