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  • Title
  • 1. Introduction
  • 2. Surgical Approach
  • 3. Port Placements and Robot Docking
  • 4. Robotic Transabdominal Dissection
  • 5. Harvest Bilateral Gracilis Muscle Flaps
  • 6. Perineal Dissection and Resection of Specimen
  • 7. Inset of Gracilis Muscle Flaps
  • 8. Closure
  • 9. Post-op Remarks

Article type:Descriptions of Clinical and Surgical Procedures

Robotic Abdominoperineal Resection (APR) with Bilateral Gracilis Muscle Flaps

5363 views

Eleanor Tomczyk, MD; Todd Francone, MD
Newton-Wellesley Hospital

General SurgeryPlastic Surgery

Manuscript Format: Case Overview

Procedure Outline

Table of Contents

  1. 1. Introduction
    1. 2. Surgical Approach
      1. 3. Port Placements and Robot Docking
        1. 4. Robotic Transabdominal Dissection
          1. 5. Harvest Bilateral Gracilis Muscle Flaps
            1. 6. Perineal Dissection and Resection of Specimen
              1. 7. Inset of Gracilis Muscle Flaps
                1. 8. Closure
                  1. 9. Post-op Remarks

                    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

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                    Authors

                    Filmed At:

                    Newton-Wellesley Hospital

                    Article Information

                    Publication Date
                    Article ID361
                    Production ID0361
                    Volume2025
                    Issue361
                    DOI
                    https://doi.org/10.24296/jomi/361