title: Prone jackknife position is not necessary to achieve a cylindrical abdominoperineal resection: demonstration of the lithotomy position.
abstract: This video demonstrates a laparoscopic abdominal perineal resection for a fixed 4.8-cm mass involving the posterior and left rectal walls and left puborectalis, 2 cm from the anal verge (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A127). We detail the steps of the procedure, all completed in lithotomy, including lateral-to-medial dissection; identification and protection of the left ureter and presacral nerves; division of the inferior mesenteric artery; medial-to-lateral dissection, with meeting the previous dissection plane; total mesorectal excision and pelvic dissection; perineal dissection and layered closure; and abdominal inspection and colostomy creation. Total operative time was 181 minutes. The specimen total mesorectal excision was complete with a negative circumferential radial margin (greater than 1 cm). Final pathology was T3N2M0.
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Keller
authors.forename: Justin K
authors.initials: JK
authors.lastname: Lawrence
authors.forename: Conor P
authors.initials: CP
authors.lastname: Delaney
mesh_terms: D000005:Abdomen / Q000601:surgery; D003125:Colostomy; D004210:Dissection; D006801:Humans; D010535:Laparoscopy; D061646:Operative Time; D056888:Patient Positioning; D010502:Perineum / Q000601:surgery; D016684:Prone Position; D012004:Rectal Neoplasms / Q000601:surgery*