Extralevator abdominoperineal excision for advanced low rectal cancer: Where to go

Figure 2 Trans-perineal minimally invasive approach for extralevator abdominoperineal excision procedure. A: The resection line of transperineal extralevator abdominoperineal excision; B: The anus was closed with a purse-string suture and an incision was made around the anus; C: The dissection was continued outside the external anal sphincter and levator muscle by using the trans-perineal trans-anal minimally invasive surgery (TAMIS) platform. The abdominal procedure was performed at the same time; D: The levator muscles were divided at the lateral most aspect by using the trans-perineal TAMIS platform. Reprinted with permission from the authors[63].