Annals of Surgical Oncology

, Volume 20, Issue 5, pp 1560–1566 | Cite as

Laparoscopic Extralevator Abdominoperineal Resection for Rectal Carcinoma with Transabdominal Levator Transection

  • Pan ChiEmail author
  • Zhi-Fen Chen
  • Hui-Ming Lin
  • Xing-Rong Lu
  • Ying Huang
Colorectal Cancer—Streaming Video



The extralevator abdominoperineal resection (ELAPR) is a new surgical technique for patients with low advanced rectal cancer. This technique requires an extra excision of the levator muscles to avoid the surgical waist caused by the conventional abdominoperineal resection, with the patient’s position changed to a prone jackknife position and using a myocutaneous flap to repair the pelvic defect. To simplify this operation, we applied a laparoscopic technique to perform controlled transabdominal transection of the levator muscles under direct visualization without a position change and pelvic floor reconstruction using human acellular dermal matrix (HADM).


In our department from 2010–2011, six patients with rectal adenocarcinoma within 3 cm of the anal verge underwent laparoscopic ELAPR with transabdominal levator transection, with no position change during the perineal operation. In three patients, pelvic reconstruction was performed with HADM.


All procedures were successfully performed without any intraoperative complications, laparoscopy-associated morbidity, or conversion to the open approach. The mean operation time and intraoperative blood loss were 186.7 min and 101.7 ml. All specimens had a cylindrical shape with levator muscles attached to the mesorectum and negative circumferential margins. No complications were seen with the use of HADM.


Laparoscopic transabdominal transection of the levator muscles without position change and with pelvic floor reconstruction using human acellular dermal matrix mesh is feasible. With the transection of the levator muscles under laparoscopic surveillance, the procedure of the extralevator abdominoperineal resection, which is aggressively invasive and operatively complicated, is simplified and has an advantage of minimal invasiveness.


Circumferential Resection Margin Myocutaneous Flap Levator Muscle Pelvic Autonomic Nerve Positive Circumferential Resection Margin 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Pan Chi
    • 1
    Email author
  • Zhi-Fen Chen
    • 1
  • Hui-Ming Lin
    • 1
  • Xing-Rong Lu
    • 1
  • Ying Huang
    • 1
  1. 1.Department of Colorectal SurgeryUnion Hospital, Fujian Medical UniversityFuzhouPeople’s Republic of China

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