title: [Application of transperineal single-port access assisted extralevator abdominoperineal excision in low rectal cancer].
abstract: OBJECTIVE
  To explore the feasibility and safety of transperineal single-port laparoscopy assisted exralevator abdominoperineal excision(TPSP-ELAPE).
  
  
  METHODS
  Three cases (2 males and 1 female) who underwent TPSP-ELAPE at lithotomy position in the Peking University People's Hospital from January to February 2016 were analyzed retrospectively. The mean age was(55.3±7.2) years. Mean body mass index (BMI) was (23.0±1.3) kg/m(2). Mean distance between tumor and anal verge was (1.8±0.3) cm. Abdominal procedure was done firstly and then perineal procedure under lithotomy position. Abdominal procedure was performed by routine laparoscopy with 5 trocars. TPSP-ELAPE procedure was performed in perineal procedure. The perineal defect was closed by purse string, followed by spindle incision around the anus. Perianal skin and subcutaneous tissue was dissected until the junction between extra anal sphincter and levator ani muscle under direct vision. Perineal skin was sutured with double purse string by 2-0 prolene, and single port canal was placed inside in order to close perineal defect. The pneumoperitoneal pressure was set to 10 mmHg and laparoscopy and instrument was placed through the single-port canal. Space between isochioanal fossa and levator ani muscle was exposed by the contraction of laparoscopic clam. Lateral and posterior side was mobilized firstly. The anterior was dissected under the help of vaginal examination and contraction by abdominal group. The levator ani muscle was divided near the initial site, and negative resection margin was confirmed in the operation. Specimen was exteriorized through the perineum.
  
  
  RESULTS
  The mean intraoperative blood loss of three cases was (123.3±25.2) ml. The total operative time was (296.7±25.1) minutes. The time used by the perineal group was (196.7±20.8) minutes. The volume of drainage was (39.0±10.1) ml at the third day after operation. The time to first stoma output was (2.3±0.6) days. The perineal drainage removal time was (7.7±0.6) days. The circumferential resection margins were negative in all specimens, and there were no perioperative complications.
  
  
  CONCLUSIONS
  TPSP-ELAPE is feasible and safe, which could avoid turning over the patient and facilitate anesthesia. It follows the anatomic plane of open ELAPE procedure with minimally invasive advantage.
authors.forename: Zhanlong
authors.initials: Z
authors.lastname: Shen
authors.affiliation: Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing 100044, China. yeyingjiang@pkuph.edu.cn.
authors.forename: Yingjiang
authors.initials: Y
authors.lastname: Ye
authors.forename: Kewei
authors.initials: K
authors.lastname: Jiang
authors.forename: Qiwei
authors.initials: Q
authors.lastname: Xie
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Yang
authors.forename: Kai
authors.initials: K
authors.lastname: Shen
authors.forename: Shan
authors.initials: S
authors.lastname: Wang
mesh_terms: D001003:Anal Canal; D016063:Blood Loss, Surgical; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D017773:Pelvic Floor; D010502:Perineum / Q000601:surgery*; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D054047:Surgical Stomas