title: [Laparoscopic-assisted anterior perineal plane for ultra-low anterior resection of the rectal cancer(APPEAR)].
abstract: OBJECTIVE
  To report a case of APPEAR performed using a laparoscopic-assisted approach.
  
  
  METHODS
  A laparoscopic-assisted APPEAR was performed with end-to-end anastomosis on October 12, 2010 for a patient with low rectal cancer who received neoadjuvant chemoradiation. After total mesorectal excision was completed laparoscopically, a crescent-shape incision was then made in the middle perineum. The distal part of the rectum was dissected with electrocautery. An double-stapling end-to-end anastomosis was performed after transaction of the rectum.
  
  
  RESULTS
  Total operative time was 195 minutes. The perineal approach cost 30 minutes. The estimated blood loss was 50 ml. First stoma output with flatus was on postoperative day 3, and the patient resumed liquid diet. The patient was discharged on postoperative day 7. There were no complications including pelvic sepsis, perineal infection, or anastomotic leak.
  
  
  CONCLUSIONS
  The APPEAR procedure can be performed safely with the abdominal approach completed laparoscopically.
authors.affiliation: Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China. qiuhzpumc@yahoo.com.cn
authors.forename: Hui-Zhong
authors.initials: HZ
authors.lastname: Qiu
authors.forename: Yi
authors.initials: Y
authors.lastname: Xiao
authors.forename: Bin
authors.initials: B
authors.lastname: Wu
authors.forename: Guo-le
authors.initials: GL
authors.lastname: Lin
authors.forename: Xin
authors.initials: X
authors.lastname: Wu
mesh_terms: D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery