Laparoscopic-assisted abdominoperineal resection in the prone position. An alternative technique

With the introduction of laparoscopic-assisted abdominoperineal resection (LAPR), the traditional Lloyd-Davies position with the Mayo two-team combined approach is being adapted. The Lloyd-Davies position allows two teams of surgeons to work simultaneously, minimizing operating time. The conditions required for laparoscopy restrict a simultaneous procedure. Since LAPR is typically performed as a two-stage procedure, we introduce an alternative position which facilitates the perineal dissection. We review the results and technique of LAPR in the prone position in three patients who were suitable candidates for this procedure. Three patients underwent LAPR. No operative or postoperative complications were encountered and the procedures were in keeping with oncologic principles of resection. Total anesthesia times were less than 3.5 h for these initial patients. No hemodynamic problems were encountered due to the choice of patient positioning. The prone jackknife position greatly increases visualization of deep structures, reduces blood loss, enhances dissection, and reduces the technical demands of the laparoscopic portion of the procedure.