Multiport Laparoscopic Abdominoperineal Resection
Despite advances in surgical techniques allowing for the preservation of the sphincter complex in the majority of patients with rectal cancer, en bloc resection of the rectum and anus using a combined abdominal and perineal approach is still required in some circumstances. Abdominoperineal resection (APR) can be performed through an open or laparoscopic approach, though the laparoscopic approach is associated with less blood loss, decreased postoperative pain and narcotic use, and shorter hospital stay. Multiport laparoscopic APR is performed in much the same manner as laparoscopic lower anterior resection for rectal cancer, adhering to the oncologic principles of high ligation on the inferior mesenteric artery and total mesorectal excision (TME). Key differences include the omission of splenic flexure mobilization and the conscious avoidance of distal mesorectal dissection off of the levator ani muscles to preserve the cylindrical nature of the specimen and avoid “wasting” at the proximal anal canal. Performance of the perineal dissection in lithotomy allows for excellent visualization in most circumstances, without the need for prone positioning. Postoperative recovery is managed according to established enhanced recovery pathways.
KeywordsAbdominoperineal resection Laparoscopic Rectal cancer Enhanced recovery
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