Uterine Manipulators Enhance Laparoscopic Rectal Surgery Outcomes: Study

A recent study published in BMC Surgery found that uterine manipulators improve surgical exposure in laparoscopic rectal procedures in women without compromising oncological or perioperative outcomes.

The research analyzed female patients undergoing laparoscopic rectal resection for benign and malignant conditions, comparing those in whom uterine manipulators were used with those operated on without them. Surgeons reported enhanced visualization of the deep pelvis, which is often restricted in women due to uterine mobility and narrower pelvic dimensions. Improved access allowed for precise dissection around critical structures such as the rectum, ureters, and neurovascular bundles, facilitating safer and more efficient surgery. Importantly, the use of uterine manipulators did not significantly increase operative time, intraoperative blood loss, or postoperative complications. Oncological parameters—including total mesorectal excision quality, lymph node harvest, and circumferential resection margin—remained consistent across both groups, confirming that manipulator use does not compromise cancer-related outcomes. Functional outcomes, such as urinary and sexual function, were similarly unaffected, reinforcing the safety of this approach.

The authors emphasize that uterine manipulators can be particularly beneficial in challenging pelvic dissections, such as low rectal tumors or in patients with obesity or a narrow pelvis. While the findings support routine consideration of manipulators in female laparoscopic rectal surgery, they also highlight the importance of surgeon experience and familiarity with the device to maximize benefits. The study concludes that uterine manipulators serve as a valuable adjunct, providing enhanced exposure and operative confidence while maintaining safety and oncological integrity. Further randomized trials and long-term follow-up studies are suggested to assess additional outcomes, including patient-reported quality of life and potential impacts on postoperative recovery. Overall, this research underscores the potential for uterine manipulators to improve technical feasibility and precision in minimally invasive rectal surgery for women.