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Prone Jackknife Position Is Not Necessary to Achieve a Cylindrical Abdominoperineal Resection: Demonstration of the Lithotomy Position

Keller, Deborah S. M.S., M.D.; Lawrence, Justin K. M.D.; Delaney, Conor P. M.D., M.Ch., Ph.D., F.R.C.S.I.

Diseases of the Colon & Rectum:
doi: 10.1097/DCR.0000000000000047
Original Contributions: Video Vignette
Abstract

This video demonstrates a laparoscopic abdominal perineal resection for a fixed 4.8-cm mass involving the posterior and left rectal walls and left puborectalis, 2 cm from the anal verge (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A127). We detail the steps of the procedure, all completed in lithotomy, including lateral-to-medial dissection; identification and protection of the left ureter and presacral nerves; division of the inferior mesenteric artery; medial-to-lateral dissection, with meeting the previous dissection plane; total mesorectal excision and pelvic dissection; perineal dissection and layered closure; and abdominal inspection and colostomy creation. Total operative time was 181 minutes. The specimen total mesorectal excision was complete with a negative circumferential radial margin (greater than 1 cm). Final pathology was T3N2M0.

Author Information

Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio

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Financial Disclosure: None reported.

Correspondence: Conor P. Delaney, M.D., M.Ch., Ph.D., F.R.C.S.I., Division of Colorectal Surgery, Department of Surgery, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106-5047. E-mail: Conor.Delaney@uhhospitals.org

© 2014 The American Society of Colon and Rectal Surgeons