Laparoscopic ultralow anterior rectal resection in APPEAR technique for deep rectal cancer

Excerpt

The key of modern rectal surgery has been the advent of total mesorectal excision (TME) [1]. Laparoscopic colorectal surgery is proven to be equivalent [2]. The Anterior Perineal Plane for Ultralow Anterior Resection of the Rectum (APPEAR) technique [3] allows a coloanal anastomosis by safe mobilization of the distal rectum and the pelvic floor musculature under direct vision, especially for the puborectal muscle and the external anal sphincter (EAS). As the APPEAR technique has only been combined with the abdominal part performed in the conventional “open” manner, we report the first case with previous laparoscopic mobilization of the rectum with TME plus mobilization of the left colon and the splenic flexure. …