Laparoscopic anterior perineal plane for ultra-low anterior resection of the rectum for low rectal cancer

Abstract

The introduction of stapling instruments and improved understanding of pathology has resulted in a greater proportion of low rectal cancer patients undergoing sphincter-preserving resection.A variety of alternative techniques have been proposed to avoid a permanent stoma,including abdominal pull through,abdominal trans-sphincteric resection and intersphincteric resection.However,these damages always inflicted on the anal sphincters with poor functional results.More recently,the anterior perineal plane for ultra-low anterior resection of the rectum (APPEAR) technique was developed which approaches the anurectum via an anterior transperineal approach and exploits an anatomic space within the pelvic floor musculature termed “rectal no-man's laud”.The ability to access this segment of distal rectum by the perineal approach may determine whether a sphincter-saving resection can be performed for a proportion of patients who would otherwise require a permanent stoma.We performed laparoscopic APPEAR for a 46-year old woman with low rectal cancer with satisfactory results. Key words: Rectal neoplasms ; Laparoscopy ; Anterior prineal plane for ultra-low anterior resection of the rectum ;