Laparoscopic-cotrolled abdominaoperineal excision with individualized levator muscle transection

Abstract

In the field of surgical treatment for low rectal cancer, the traditional abdominoperineal excision (APE) do not benefit much from the total mesorectal excision (TME) prinple, but is trapped by the so-called ʺsurgical waistʺ and associated oncological inferiorities. The safety of a more radical procedure, the extralevator abdominoperineal resection (ELAPR) is still under debate. Owing to the advancement of laparoscopic techniques, we developed a laparoscopy-cotrolled APE (LCAPE) procedure for stage I-III patients. During the procedure, a controlled incision of levators into the ischiorectal fat was performed transabdominally under direct vision; the meeting plane is therefore lowered and the perineal dissection simplified without changing body position. This laparoscopic guided technique has innate advantages in neurovascular preservation, and offers individualized transection of levator muscles, minimizes the risk of wound complications and prevents surgical waist to ensure oncological safety. Key words: Laparoscopes; Rectal neoplasms; Surgical procedures, operative