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Current laparoscopic technologies do not permit a truly perpendicular rectal staple line. An incision is often made to divide the lower rectum with standard open surgical staplers. Our method places the crossstapler under laparoscopic guidance. Place the cross-stapler through the finger of a surgical glove and secure. Stretching the cuff around the wound protector (Fig 1) permits reinsufflation and stapler deployment across the low rectum under direct laparoscopic vision. We find this technique to be helpful in performing ultra-low division of the rectum for a laparoscopic ileo-anal pouch in the presence of massive uterine fibroids without conversion to an open procedure.

Laparoscopic use of a 90-degree cross-stapling device for low rectal division