Single port-assisted fully laparoscopic abdominoperineal resection (APR) with immediate V-RAM flap reconstruction of the perineal defect

Abstract

Abdominoperineal resection (APR) of anorectal cancers after neoadjuvant chemoradiotherapy may incur significant perineal morbidity. While vertical rectus abdominis muscle (V-RAM) flaps can fill the pelvic resection space with health tissue, their use has previously been described predominantly in association with laparotomy. Here, we describe a means of combination laparoscopic APR with V-RAM flap reconstruction that allows structural preservation of the entire abdominal wall throughout the oncological resection and of the deep parietal layers after V-RAM donation. Furthermore, a single port access device used at the end colostomy site allows a second senior surgeon assist with an additional two working instruments for the purpose of improved pelvic tissue retraction, especially useful in obese patients.

Single incision laparoscopic surgery for Meckel’s diverticulum in an adult

“…It permits the access of multiple standard laparoscopic instruments through a single opening in the umbilicus (figure 2). The main challenges are technical (loss of triangulation, clashing of instruments and lack of manoeuvrability) resulting in a significant longer learning curve and increased operative time 2. We demonstrate that SILS is feasible, safe and cosmetically advantageous3 to standard laparoscopy for the treatment of MD in an adult.…”

Omental pedicle flaps following proctectomy: a systematic review

“…Primary healing rates range from 45 to 91% depending on the study, population, surgical technique and underlying disease process . To circumvent this a variety of complex, costly and time‐consuming wound management techniques incorporating tissue transfer, such as vertical rectus abdominis (VRAM) and gracilis flap construction, have been advocated .…”

Omentoplasty to assist perineal defect closure following laparoscopic abdominoperineal resection

“…While conferring the benefits of a laparoscopic procedure, the attendant perineal wound complications remain . Wound management techniques such as vertical rectus abdominis and gracilis flaps may negate many advantages of the laparoscopic approach . Given the ability to easily and safely access the upper abdomen with the laparoscope, omental mobilization for pelvic transposition is attractive in laparoscopic APR.…”