Laparoscopic extralevator abdominoperineal resection for rectal carcinoma with transabdominal levator transection.
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.
Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, People's Republic of China. cp3169@163.com
Pan
P
Chi
Zhi-Fen
ZF
Chen
Hui-Ming
HM
Lin
Xing-Rong
XR
Lu
Ying
Y
Huang
D000005:Abdomen / Q000601:surgery; D062088:Acellular Dermis; D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery*; D061646:Operative Time; D056888:Patient Positioning; D017773:Pelvic Floor / Q000601:surgery*; D010502:Perineum / Q000601:surgery; D012004:Rectal Neoplasms / Q000601:surgery*