Abstract
INTRODUCTION: Anastomotic leakage is a major complication after low anterior resection for rectal cancer, particularly in transanal total mesorectal excision (taTME) cases, where the low anastomotic level makes conventional leak testing difficult. We developed a novel leak test using the AirSeal system to improve intraoperative detection of leakage in such cases. MATERIALS AND SURGICAL TECHNIQUE: This technique was applied in patients undergoing low anterior resection combined with taTME for lower rectal cancer within 10 cm of the anal verge, reconstructed using the single-stapling technique. After anastomosis, the AirSeal system was set to a flow rate of 20 L/min and a pressure of 8 mmHg, while laparoscopic intra-abdominal pressure was maintained at 10-12 mmHg. The pelvic cavity was filled with saline, and the anastomosis was inspected for air or water column leakage. DISCUSSION: The AirSeal-assisted leak test may be helpful for reliable intraoperative identification of anastomotic leakage by utilizing a controlled pressure differential. It may facilitate the prevention of leakage and stenosis, warranting further prospective validation.