Uterine Manipulators may Enhance Laparoscopic Rectal Surgery in Women: Study

A recent study published in BMC Surgery found that using uterine manipulators during laparoscopic rectal resections in women enhances operative exposure without compromising oncological safety or perioperative outcomes. The researchers compared cases where a manipulator was employed to those without, observing that its use provided better visualization and access to the deep pelvis—crucial in women, whose pelvic anatomy and potential uterine mobility can complicate dissection. Despite the improved surgical ergonomics, the study reported no increase in operative times, blood loss, complication rates, or positive margin occurrences. Moreover, functional outcomes post-surgery—including urinary and sexual function—remained equivalent between both groups. This suggests that using uterine manipulators is both safe and beneficial, especially in complex cases such as low rectal tumors or narrow female pelvises. The enhanced exposure facilitated by the manipulator allows for a more precise and controlled dissection, potentially reducing technical difficulty and improving surgeon confidence. Importantly, there was no negative impact on oncological principles: specimen quality, lymph node yield, and circumferential margin status were similar with or without the device. The authors conclude that for difficult pelvic dissections in female patients, uterine manipulator use is a valuable adjunct that doesn’t compromise safety or outcomes. However, they note that surgeon experience and familiarity with the device remain important considerations, and they encourage further randomized studies to quantify benefits on operative ergonomics, long-term outcomes, and patient quality of life.