V2 Prone abdomeno perineal excision of rectum

Abstract

Traditionally, the perineal dissection during an Anbdomeno‐perineal resection of the rectum (APER) is conducted in conjunction with the trans‐abdominal pelvic dissection with the patient in Lloyd‐Davis and then the Lithotomy positions. There is a higher local recurrence rate in APER as compared to restorative anterior resection. The current practices in APER often result in a ‘surgical waist’ in the resection specimen, which might threaten the resection margin. There are many advantages to performing the perineal dissection with the patient in a prone Jack‐Knife position. The oncological benefit is that it facilitates the achievement of a more cylindrical resection specimen, giving a wider resection margin and hence lowering the risk of local recurrence. This video utilises annotated diagrams and a high definition digital recording of the perineal dissection in a 52 year old male patient with a low rectal cancer undergoing APER, following neo‐adjuvant long course chemo‐radiotherapy. We demonstrate how the use of the prone jack‐knife position gives excellent exposure and improved surgical access, facilitating a better oncological resection.