Robotic Abdominoperineal Resection (APR) with Bilateral Gracilis Muscle Flaps

1. Introduction

2. Surgical Approach

1. Rectal Exam
2. Flexible Sigmoidoscopy
3. Marking

3. Port Placements and Robot Docking

1. Dock Robot

4. Robotic Transabdominal Dissection

1. Pelvic Brim Dissection
2. Examine Redundancy of Sigmoid Colon and Retract out of Pelvis
3. Medial-to-Lateral Colon Mobilization Starting at IMA Pedicle
4. Pelvic Dissection and Develop Plane
5. TME Dissection
6. Add 12-mm Port for Stapler
7. Division of IMA Pedicle Distal to Left Colic Artery
8. Transection of Colon
9. Hemostasis
10. Suture Drain to Sigmoid Stump

5. Harvest Bilateral Gracilis Muscle Flaps

1. Left Side
2. Right Side

6. Perineal Dissection and Resection of Specimen

1. Close Anus with Purse-String Suture
2. Approach
3. Take Margins
4. Hemostasis
5. Review

7. Inset of Gracilis Muscle Flaps

1. Subcutaneous Tunnels to Bring Flaps into Perineum
2. Closure of Right Proximal Graft Incision

8. Closure

9. Post-op Remarks