LAUSR

The American Society of Colon and Rectal Surgeons guidelines for the management of rectal cancer recommend rectal washout be performed before rectal resection (1). Clamping the rectum allows the staple line to be oncologically safely washed out and conveniently allows adjustments to a linear stapler for rectal resection (2). In robot-assisted laparoscopic rectal surgery in Japan, clamping with detachable bowel clamps by patient-side surgeons is the mainstream method. However, even in robot-assisted laparoscopic surgery, clamping using detachable bowel clamps performed by patient-side surgeons is associated with some difficulties. Interference between instruments from the assistant port and robot arms can occur both intra- and extraabdominally in the narrow pelvic space (3). While the ideal insertion angle of clamps to the rectum is the right angle, the adjustment of the clamp insertion angle via the assistant port placed in the upper abdomen is difficult in patients with a deep pelvis. To overcome these difficulties, we devised a novel method of clamping the rectum in robot-assisted laparoscopic rectal surgery that can be performed using only robot-arms, known as the "simple clamping technique".