Abstract
BACKGROUND: Laparoscopic rectal surgery in female patients poses challenges due to limited pelvic space and obstructing reproductive structures. Uterine manipulators, widely used in gynecological surgery, may enhance intraoperative exposure during rectal resections, but evidence in colorectal settings is sparse. METHODS: This retrospective cohort study included 40 female patients undergoing laparoscopic rectal cancer surgery between October 2024 and January 2025. Patients were divided into two groups based on the use of a uterine manipulator. Preoperative characteristics, intraoperative findings, and postoperative outcomes were compared, including exposure quality, operative time, lymph node harvest, neoadjuvant treatment response, and recovery parameters. RESULTS: Intraoperative exposure was significantly better in the manipulator group (VAS 8.8 ± 0.9 vs. 6.05 ± 1.5; p < 0.001). Other perioperative parameters such as operative time, bleeding, lymph node harvest, and ICU admission showed no statistically significant differences. Among patients who received neoadjuvant therapy, pathological response did not differ between groups. Hospital stay was slightly shorter and pain scores marginally higher in the manipulator group, without statistical significance. CONCLUSION: Uterine manipulators significantly improve exposure during laparoscopic rectal surgery in women without adversely affecting oncological or perioperative outcomes. They may be considered a useful adjunct in challenging pelvic dissections.