Transabdominal extralevator abdominoperineal excision (eLAPE) performed by laparoscopic approach with no position change

Abstract

As a new surgical technique, extralevator abdominoperineal excision (eLAPE) is recommended for the treatment of low rectal cancer. The patient's position is changed to a prone jackknife position before extralevator excision is performed via the perineal approach. Whether the extralevator excision can be completed through a transabdominal route under laparoscopy is controversial. This study was designed to introduce a modified technique of laparoscopic-assisted eLAPE and to evaluate the feasibility and safety of this technique. With no change of position, laparoscopic eLAPE was performed in 12 patients with low rectal cancer through a transabdominal route between February 2012 and August 2013. There was no case with bowel perforation and positive circumferential resection margins among these 12 patients. The mean operative time was 177.1 minutes, and the mean intraoperative blood loss was 92.5 mL. The mean time to passing of first flatus was 2.3 days, and the mean postoperative hospital stay was 7.5 days. There was no case with bladder dysfunction. No patients suffered from sexual dysfunction during the follow-up period. Without the change of the patient's position, eLAPE can be performed through a transabdominal route by the laparoscopic approach. The procedure of the former eLAPE is simplified without compromising oncologic outcome.