Single port-assisted fully laparoscopic abdominoperineal resection (APR) with immediate V-RAM flap reconstruction of the perineal defect.
Abdominoperineal resection (APR) of anorectal cancers after neoadjuvant chemoradiotherapy may incur significant perineal morbidity. While vertical rectus abdominis muscle (V-RAM) flaps can fill the pelvic resection space with health tissue, their use has previously been described predominantly in association with laparotomy. Here, we describe a means of combination laparoscopic APR with V-RAM flap reconstruction that allows structural preservation of the entire abdominal wall throughout the oncological resection and of the deep parietal layers after V-RAM donation. Furthermore, a single port access device used at the end colostomy site allows a second senior surgeon assist with an additional two working instruments for the purpose of improved pelvic tissue retraction, especially useful in obese patients.
Department of Plastic and Colorectal Surgery, Beaumont Hospital, Dublin, Ireland.
Sayid
S
Ali
Mohamed
M
Moftah
Nadeem
N
Ajmal
Ronan A
RA
Cahill
D015179:Colorectal Neoplasms / Q000628:therapy; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D017568:Rectus Abdominis / Q000601:surgery*; D013524:Surgical Flaps; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000601:surgery*