Abdominal perineal resection (APR) of rectum

Laparoscopic abdominal perineal resection (APR) of rectum, using a monopolar hook

Laparoscopic abdominal perineal resection (APR) of rectum, using a monopolar hook
Professor Puchkov K.V. is performing an operation (2018).

In this film the technique of performing of abdominal perineal resection (APR) of rectum with the expanded lymphadenectomy, using a monopolar “hook” electrode is presented. A 59 year-old female patient was treated with the diagnosis: Low rectal cancer fT3N1M0, G1. She had a course of neoadjuvant chemotherapy (CLT) with preoperative radiotherapy.
Exposure of rectum had done within the injuring of mesorectal fascia, with preserving the structures of upper and lower hypogastral plexus (sympatic and parasympatic nerves) laparoscopically. The “classical” positioning of trocars had been used: in the right and left iliac area, and in the mesogastric area to the left. The operation was started with dissection of pelvic in the right side of rectum, then exposure of rectum along the posterior wall with identification of the left ureter. Lymphodissection was performed in the area of origin of the inferior mesenteric artery, transection of superior rectal artery (with preserving of the left colic artery) was done with a 5 mm “LigaSure” («MEDTRONIC COVIDIEN») instrument. The next stage was dissection of the left lateral canal and mobilization of the descending part of the colic colon. Exposure of rectum up to pelvic floor along the posterior semicircumference took place within the injuring of the mesorectal fascia, then along the right and left semicircumference, and only at the end-along the anterior wall. Transection of the large colon in its proximal part had performed with EndoGIA-60 (a blue reload) device («MEDTRONIC COVIDIEN»).
The perineal stage had done in a classical approach. Stoma was created in the left iliac area. The drainage was placed via perineal wound. Operation duration was about 150 minutes.

You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.

Laparotomic and perineal total exenteration of small pelvis with expanded vulvectomy and extirpation of rectum

Laparotomic and intermediate total exenteration of small pelvic with the expanded vulvectomy and rectum extirpation.
Doctor Todua I.V. is performing an operation (2017).

In this video the technique of total exenteration of small pelvis with the expanded vulvectomy and extirpation of rectum in a 69 year-old patient, operated in 2016 with the further chemoradial therapy, is demonstrated. The local relapse in 2017 with involvement of the urinary bladder and rectum took place. The operation starts with the perineal access and removal of tumour, urinary bladder and extirpation of rectum en block. Then the perineal wound is closed according to VRAM technique. And finally, the abdominal stage begins with urine diversion into the iliac colon and exteriorization of colostoma onto the abdominal wall.