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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2013

01-05-2013 | Colorectal Cancer—Streaming Video

Laparoscopic Extralevator Abdominoperineal Resection for Rectal Carcinoma with Transabdominal Levator Transection

Authors: Pan Chi, MD, Zhi-Fen Chen, MD, Hui-Ming Lin, MD, Xing-Rong Lu, PhD, MD, Ying Huang, PhD, MD

Published in: Annals of Surgical Oncology | Issue 5/2013

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Abstract

Background

The extralevator abdominoperineal resection (ELAPR) is a new surgical technique for patients with low advanced rectal cancer. This technique requires an extra excision of the levator muscles to avoid the surgical waist caused by the conventional abdominoperineal resection, with the patient’s position changed to a prone jackknife position and using a myocutaneous flap to repair the pelvic defect. To simplify this operation, we applied a laparoscopic technique to perform controlled transabdominal transection of the levator muscles under direct visualization without a position change and pelvic floor reconstruction using human acellular dermal matrix (HADM).

Methods

In our department from 2010–2011, six patients with rectal adenocarcinoma within 3 cm of the anal verge underwent laparoscopic ELAPR with transabdominal levator transection, with no position change during the perineal operation. In three patients, pelvic reconstruction was performed with HADM.

Results

All procedures were successfully performed without any intraoperative complications, laparoscopy-associated morbidity, or conversion to the open approach. The mean operation time and intraoperative blood loss were 186.7 min and 101.7 ml. All specimens had a cylindrical shape with levator muscles attached to the mesorectum and negative circumferential margins. No complications were seen with the use of HADM.

Conclusions

Laparoscopic transabdominal transection of the levator muscles without position change and with pelvic floor reconstruction using human acellular dermal matrix mesh is feasible. With the transection of the levator muscles under laparoscopic surveillance, the procedure of the extralevator abdominoperineal resection, which is aggressively invasive and operatively complicated, is simplified and has an advantage of minimal invasiveness.
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Metadata
Title
Laparoscopic Extralevator Abdominoperineal Resection for Rectal Carcinoma with Transabdominal Levator Transection
Authors
Pan Chi, MD
Zhi-Fen Chen, MD
Hui-Ming Lin, MD
Xing-Rong Lu, PhD, MD
Ying Huang, PhD, MD
Publication date
01-05-2013
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 5/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2675-x

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