Transperineal approach alone as minimally invasive surgery for pelvic recurrence of rectal cancer after abdominoperineal resection

Introduction: In this report, we describe a case of pelvic recurrence of rectal cancer invading a seminal vesicle after abdominoperineal resection, which was removed only by a transperineal approach with the addition of urethrography. Case: The patient, a man in his 60s, underwent laparoscopic abdominoperineal resection for lower rectal cancer at another hospital. Thirty months after the surgery, he was referred to our department for surgery for a recurrent tumor in the pelvis. Magnetic resonance imaging showed a tumor on the dorsal prostate that was suspected to have invaded a seminal vesicle. Surgical findings: After incision in the previous perineal surgical wound, a subcutaneous incision was made and a GelPOINT mini was attached. Airflow was applied with the AirSeal system, and the surgery was performed laparoscopically. To accurately identify the dissection layers and avoid urethral injury, intraoperative urethrography was performed as necessary, and dissection was performed with an electrocautery and ultrasonic coagulation incision device while confirming the position of the urethra and forceps. The prostate was safely identified by urethrography and separated from the firm tumor. After dissecting the fatty tissue surrounding the tumor, the affected seminal vesicle was partially resected. The dorsal side of the tumor was dissected using the coccygeal bone and the levator ani muscle as guides, and the tumor was removed. Conclusion: In select cases, the TaTME technique may allow minimally invasive surgery using only a transanal or transperineal approach.