V2Prone abdomeno perineal excision of rectum

Traditionally, the perineal dissection during an Anbdomeno-perineal resection of the rectum (APER) is conducted in conjunction with the trans-abdominal pelvic dissection with the patient in Lloyd-Davis and then the Lithotomy positions. There is a higher local recurrence rate in APER as compared to restorative anterior resection. The current practices in APER often result in a 'surgical waist' in the resection specimen, which might threaten the resection margin. There are many advantages to performing the perineal dissection with the patient in a prone Jack-Knife position. The oncological benefit is that it facilitates the achievement of a more cylindrical resection specimen, giving a wider resection margin and hence lowering the risk of local recurrence. This video utilises annotated diagrams and a high definition digital recording of the perineal dissection in a 52 year old male patient with a low rectal cancer undergoing APER, following neo-adjuvant long course chemo-radiotherapy. We demonstrate how the use of the prone jack-knife position gives excellent exposure and improved surgical access, facilitating a better oncological resection.