title: Novel technique of robotic extralevator abdominoperineal resection with gracilis flap closure.
abstract: BACKGROUND
  The purpose of this paper is to introduce a robotic assisted approach to extralevator abdominoperineal excision in the modified Lloyd-Davis position with reconstruction of the perineum using pedicled gracilis flaps, and to discuss outcomes in a cohort of six patients.
  
  
  METHODS
  Data was collected by chart review on six patients who underwent extralevator excision with gracilis flap reconstruction from 10/2013 to 06/2015. Technical details, operative data, oncologic outcomes, and wound healing complications were evaluated.
  
  
  RESULTS
  There were no instances of intraoperative perforation or positive circumferential resection margin, and one case of locoregional recurrence. Two patients experienced flap venous congestion and one patient developed a perineal abscess. All patients went on to complete healing.
  
  
  CONCLUSIONS
  The combination of a minimally invasive robotic assisted extralevator abdominoperineal excision performed in the modified Lloyd-Davis position with reconstruction of the perineum with pedicled gracilis flaps has excellent oncologic outcomes and acceptable wound healing complications. Copyright © 2016 John Wiley & Sons, Ltd. StartCopTextCopyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Plastic Surgery, Wright State University, Dayton, OH, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Sieffert
authors.affiliation: Division of Surgical Oncology, Wright State University, Dayton, OH, USA.
authors.forename: James
authors.initials: J
authors.lastname: Ouellette
authors.affiliation: Department of Plastic Surgery, Wright State University, Dayton, OH, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Johnson
authors.affiliation: Premier Plastic Surgeons, Dayton, OH, USA.
authors.forename: Todd
authors.initials: T
authors.lastname: Hicks
authors.affiliation: Division of Surgical Oncology, Wright State University, Dayton, OH, USA.
authors.forename: Minia
authors.initials: M
authors.lastname: Hellan
mesh_terms: D000005:Abdomen / Q000601:surgery; D000368:Aged; D005260:Female; D000071976:Gracilis Muscle / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010502:Perineum / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D012004:Rectal Neoplasms / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D013524:Surgical Flaps / Q000009:adverse effects / Q000098:blood supply; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome; D014945:Wound Healing
keywords: ELAPE; extralevator APR; extralevator abdominoperineal resection; gracilis flap; pedicled gracilis flap; perineal reconstruction; robotic-assisted