Abdominoperineal Excision of Rectum (Laparoscopic)
OPERATION: Laparoscopic Abdominoperineal Excision of Rectum (APER)
ANAESTHETIC: General anaesthesia
ANTIBIOTICS: Gentamicin and Metronidazole
ABDOMINAL ACCESS:
Cut-down at epigastrum for 12mm port.
12mm and 5mm right iliac fossa ports. 5mm left iliac fossa port. All under direct vision.
FINDINGS: [Low rectal tumour. No signs of tumour spread].
ABDOMINAL PROCEDURE:
Medial to lateral dissection. Left ureter identified and preserved.
IMA pedicle secured with Hem-o-lok clips.
TME dissection to level of coccyx posteriorly and below seminal vesicles anteriorly.
Stomal opening fashioned at premarked left iliac fossa site.
End colostomy delivered through marked site.
ABDOMINAL CLOSURE:
PDS to epigastric port and lower midline. Staples to skin. Vicryl to stoma.
PERINEAL PROCEDURE (prone position):
ELAPE dissection. Specimen removed from below.
Pelvic floor closed with XCM mesh fixed with PDS.
PERINEAL CLOSURE:
Subcutaneous Vicryl x2 layers. Vicryl to skin. Collatamp between layers.
POST-OPERATIVE INSTRUCTIONS:
Enhanced recovery. Regular observations.
VTE prophylaxis with extended Dalteparin on discharge.
Fluids as tolerated. Mobilise. Catheter out at 48 hours.