Laparoscopic pelvic reperitonization after abdominoperineal resection in a female patient

This video presents a stepwise approach to perform the pelvis’ reperitonization following removal of the rectum after an abdominoperineal resection in a female patient. The surgeon uses absorbable monofilament suture material that is much easier to manipulate. Two half running sutures with an intracorporeal stitch are used for a complete reperitonization by using the genital organs, in particular the left and right broad ligaments, along with the uterus.

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Laparoscopic pelvic reperitonization after abdominoperineal resection in a female patient

Authors

J Leroy, J Marescaux

Abstract

This video presents a stepwise approach to perform the pelvis’ reperitonization following removal of the rectum after an abdominoperineal resection in a female patient. The surgeon uses absorbable monofilament suture material that is much easier to manipulate. Two half running sutures with an intracorporeal stitch are used for a complete reperitonization by using the genital organs, in particular the left and right broad ligaments, along with the uterus.

Classification

tips and tricks

Keywords

Reperitonization, abdominoperineal resection, APR

Media type

Surgical video

Duration

03'36''

Publication

2009-03

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E-publication

WeBSurg.com, Mar 2009;9(03).
URL: http://www.websurg.com/doi-vd01en2556.htm

Laparoscopic pelvic reperitonization after abdominoperineal resection in a female patient

1. Clinical case presentation 00'17''

The purpose of this video is to show the pelvis’ reperitonization following the rectum’s removal after an abdominoperineal resection in a female patient. This is much easier in a woman as we can use the uterus and the peri-uterine peritoneum, embodied by the broad ligament, to perform a complete closure of the pelvis.

2. First half running suture 00'39''

To do this, we use absorbable monofilament suture material that is much easier to manipulate as it allows to place multiple stitches before having to place traction, which also saves time. For this operative step, right from the start of the procedure, we preserve as much peritoneum as possible at the level of the root of the mesosigmoid and mesorectum. This is done in order to use the peritoneal flap to cover up the whole pelvis medially. It is exceptional to only use one suture. In these cases, we perform two half running sutures with an intracorporeal stitch which will allow for a complete reperitonization by using the genital organs, in particular the left and right broad ligaments, along with the uterus. Using a monofilament eases the operator’s manoeuvres.

3. Second half running suture and completion of reperitonization 01'46''

Many surgeons do not believe this closure to be necessary; however, if we do wish to do it, it is always possible. This can be harder in male patients, but it is also possible as long as it has been prepared for straight from the start of the procedure by keeping as much peritoneal flap as possible to allow for a tension-free closure of the pelvic space. Once the closure has been performed, we can complete the surgery via a perineal approach after having performed the colostomy, or at least after having prepared the colostomy in the left iliac fossa or via a left transrectal route.

4. Final view of operative field 03'23''

Here is the final view of the operative field and we can see that the lavage has been thoroughly carried out in the abdominal cavity, and that we have achieved a perfect separation between the pelvic space and the peritoneal space.