Outcomes of Robotic Partial Excision of the Levator Ani Muscle for Locally Advanced Low Rectal Cancer Invading the Ipsilateral Pelvic Floor at the Anorectal Ring Level

2021 ◽  
Author(s):  
Seung Yoon Yang ◽  
Min Soo Cho ◽  
Nam Kyu Kim
Keyword(s):  
Rectal Cancer ◽  
Pelvic Floor ◽  
Locally Advanced ◽  
Levator Ani ◽  
Low Rectal Cancer ◽  
Levator Ani Muscle ◽  
Anorectal Ring ◽  
Partial Excision

scholarly journals Robotic Partial Excision of Levator-Ani Muscle for Locally Advanced Low Rectal Cancer Invading Ipsilateral Pelvic Floor

2020 ◽  
Vol 36 (6) ◽  
pp. 415-416
Author(s):  
Seung Yoon Yang ◽  
Nam Kyu Kim
Keyword(s):  
Rectal Cancer ◽  
Resection Margin ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Levator Ani ◽  
Low Rectal Cancer ◽  
Levator Ani Muscle ◽  
Surgical Specimen ◽  
Alternative Treatment Option ◽  
Partial Excision

Tumors at the level of the anorectal junction had required abdominoperineal resection (APR) to achieve an adequate resection margin. However, in the cases of tumor invading ipsilateral levator-ani muscle (LAM), <i>en-bloc</i> resection of the rectum with LAM including tumor would be possible. This video is to show the critical anatomic steps of this procedure. A video was produced from the robotic right partial excision of LAM (PELM) performed in a 57-year-old female patient with rectal cancer at 3 cm from the anal verge, invading the ipsilateral anorectal ring, who had received neoadjuvant chemoradiotherapy. The patient discharged at postoperative day 8 without complication. The pathology of the surgical specimen revealed ypT3N1bM0. The secure resection margin from the tumor was achieved. Robotic PELM is the sphincter-preserving technique that can be an alternative treatment option for low rectal cancer invading the ipsilateral LAM, which has been an indication for APR or extralevator APR.

Causes of Fecal and Urinary Incontinence After Total Mesorectal Excision for Rectal Cancer Based on Cadaveric Surgery: A Study From the Cooperative Clinical Investigators of the Dutch Total Mesorectal Excision Trial

2008 ◽  
Vol 26 (27) ◽  
pp. 4466-4472 ◽  
Author(s):  
Christian Wallner ◽  
Marilyne M. Lange ◽  
Bert A. Bonsing ◽  
Cornelis P. Maas ◽  
Charles N. Wallace ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Urinary Incontinence ◽  
Fecal Incontinence ◽  
Pelvic Floor ◽  
Total Mesorectal Excision ◽  
Levator Ani ◽  
Levator Ani Muscle ◽  
Mesorectal Excision ◽  
Splanchnic Nerves ◽  
Pelvic Splanchnic Nerves

Purpose Total mesorectal excision (TME) for rectal cancer may result in anorectal and urogenital dysfunction. We aimed to study possible nerve disruption during TME and its consequences for functional outcome. Because the levator ani muscle plays an important role in both urinary and fecal continence, an explanation could be peroperative damage of the nerve supply to the levator ani muscle. Methods TME was performed on cadaver pelves. Subsequently, the anatomy of the pelvic floor innervation and its relation to the pelvic autonomic innervation and the mesorectum were studied. Additionally, data from the Dutch TME trial were analyzed to relate anorectal and urinary dysfunction to possible nerve damage during TME procedure. Results Cadaver TME surgery demonstrated that, especially in low tumors, the pelvic floor innervation can be damaged. Furthermore, the origin of the levator ani nerve was located in close proximity of the origin of the pelvic splanchnic nerves. Analysis of the TME trial data showed that newly developed urinary and fecal incontinence was present in 33.7% and 38.8% of patients, respectively. Both types of incontinence were significantly associated with each other (P = .027). Low anastomosis was significantly associated with urinary incontinence (P = .049). One third of the patients with newly developed urinary and fecal incontinence also reported difficulty in bladder emptying, for which excessive perioperative blood loss was a significant risk factor. Conclusion Perioperative damage to the pelvic floor innervation could contribute to fecal and urinary incontinence after TME, especially in case of a low anastomosis or damage to the pelvic splanchnic nerves.

325 THE LFG-COMPLEX (LEVATOR ANI MUSCLE - FOSSA ISCHIOANALIS - GLUTEUS MAXIMUS MUSCLE) AND ITS ROLE FOR THE FUNCTIONAL INTEGRATION OF THE PELVIC FLOOR

2007 ◽  
Vol 6 (2) ◽  
pp. 104
Author(s):  
I. Soljanik ◽  
U. Janssen ◽  
A. Lienemann ◽  
H. Fritsch ◽  
E.R. Weissenbacher ◽  
...  
Keyword(s):  
Pelvic Floor ◽  
Functional Integration ◽  
Gluteus Maximus ◽  
Levator Ani ◽  
Levator Ani Muscle ◽  
Gluteus Maximus Muscle

scholarly journals Attachment of the levator ani muscle extends to the superior ramus of the pubic bone through electrophysiological and anatomical examinations

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hung-Yen Chin ◽  
Chih-Wei Peng ◽  
Ming-Ping Wu ◽  
Chih-Hwa Chen ◽  
Yu-Ting Feng ◽  
...  
Keyword(s):  
Pelvic Floor ◽  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Pelvic Floor Muscle ◽  
Levator Ani ◽  
Pubic Bone ◽  
Levator Ani Muscle ◽  
Cadaver Dissection ◽  
Inferior Border ◽  
Stimulation Of

AbstractMyofascial pelvic pain (MFPP) of pelvic floor muscles is a common cause of chronic pelvic pain (CPP). The pathological mechanisms and treatments of MFPP are complex and still unclear until now. The levator ani muscle (LAM) is the major pelvic floor muscle. The purpose of this study was to examine the fascia and attachment of LAM through the electromyogram (EMG) and cadaver dissection. Electrophysiological stimulation of the obturator fascia above the arcus tendinous levator ani (ATLA) could trigger contraction and electrophysiological changes in LAM insertion. The LAM of embalmed adult cadavers was examined especially in the area above the ATLA. Some skeletal muscle fibers were found above the ATLA within the obturator fascia and were confirmed by Masson’s trichrome section staining. Our electromyography (EMG) and anatomical data implied that the attachment of LAM aponeurosis extended beyond ATLA to the inferior border of the superior ramus of the pubic bone. The new discovered attachment of LAM could provide a reference position for clinical diagnosis and treatment of MFPP or CPP.

scholarly journals Preliminary Outcome of Individualized Abdominoperineal Excision for Locally Advanced Low Rectal Cancer

2018 ◽  
Vol 131 (11) ◽  
pp. 1268-1274 ◽  
Author(s):  
Yi Zheng ◽  
Jia-Gang Han ◽  
Zhen-Jun Wang ◽  
Zhi-Gang Gao ◽  
Guang-Hui Wei ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Abdominoperineal Excision ◽  
Low Rectal Cancer

Comparison of Different Nodal Staging in Patients With Locally Advanced Mid-low Rectal Cancer After Long-term Neoadjuvant Chemoradiation Therapy

2019 ◽  
Vol 39 (4) ◽  
pp. 2113-2120
Author(s):  
NICCOLÒ PETRUCCIANI ◽  
MARIA CLOTILDE CARRA ◽  
ALEIX MARTÍNEZ-PÉREZ ◽  
GIULIO CESARE VITALI ◽  
FILIPPO LANDI ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiation ◽  
Chemoradiation Therapy ◽  
Low Rectal Cancer ◽  
Nodal Staging ◽  
Neoadjuvant Chemoradiation Therapy
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