Updates in Surgery

, Volume 64, Issue 3, pp 217–221 | Cite as

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

  • Sayid Ali
  • Mohamed Moftah
  • Nadeem Ajmal
  • Ronan A. Cahill
Technical Note


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.


Anorectal cancer Laparoscopic abdominoperineal resection Single port laparoscopy Vertical rectus abdominis muscle (V-RAM) flap 


Conflict of interest

The authors declare no conflict of interest.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Sayid Ali
    • 1
  • Mohamed Moftah
    • 1
  • Nadeem Ajmal
    • 1
  • Ronan A. Cahill
    • 1
  1. 1.Departments of Plastic and Colorectal SurgeryBeaumont HospitalDublinIreland

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