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Laparoscopic surgery for rectal cancer is associated with significant morbidity. We analysed the impact of technical modifications on surgical outcome after laparoscopic sphincter-preserving rectal excision.Between 2000 and 2009, surgical treatment of rectal cancer was standardised including high vascular ligation, mesorectal excision and intracorporeal stapled anastomosis with loop ileostomy. From 2006, the rectal staplingprocedure was modified increasing the stapler size (4.8 vs 3.5 mm) and decreasing the median number of cartridges (2 vs 3). We compared operative mortality, pelvic sepsis (leak or abscess) and reoperation between the first (2000-2005) and the second period (2006-2009).Laparoscopic sphincterpreserving rectal excision was performed in 387 patients: 208 during the first period and 179 during the second. The groups were similar for patient's and tumour's characteristics. There was no difference of mortality between the two periods: 1.0% vs 0.6%. By contrast, the rate of both pelvic sepsis (8% vs 17%; P = 0.001) and reoperation (7% vs 18%; P = 0.001) decreased significantly during the second period compared to the first period.By reducing the number of cartridges and using adapted staplers size, we reduced by half surgical complication, suggesting the impact of adapted tools to optimize surgical outcome after laparoscopic TME.