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Rectal cancer with invasion of adjacent pelvic organs is uncommon and poses significant operative challenges. Multimodal treatment combining neoadjuvant therapy and precise surgical technique is often required to achieve negative margins while preserving function.

We present a video of an 80-year-old female with low rectal adenocarcinoma (ypT4bN0M0) invading the posterior vaginal wall following chemoradiotherapy. A laparoscopic abdominoperineal resection with en bloc partial vaginectomy was performed, followed by reconstruction using a left gracilis myocutaneous flap. The minimally invasive approach provided excellent pelvic exposure and facilitated accurate dissection despite post-radiation fibrosis.

The patient had an uneventful postoperative recovery and was discharged on postoperative day 14 with no complications. Pathology confirmed R0 resection with no nodal involvement. At 6-month follow-up, the patient remained disease-free with satisfactory functional recovery.

This case demonstrates that, in selected patients and experienced centers, laparoscopic APR combined with reconstructive techniques offers a safe and effective option for locally advanced rectal cancer invading the vagina.

A step-by-step guide to performing a laterally-based bilobed transposition flap for nasal tip reconstruction.

sural distal

Deep Inferior Epigastric Perforator Flap: Abdominal Closure and Flap Inset

This video depicts the abdominal closure and DIEP flap inset for a delayed bilateral deep inferior epigastric perforator (DIEP) flap reconstruction in a 53-year-old patient status post bilateral mastectomy for breast cancer.

Authors: Eva Niklinska B.S., Vincent Riccelli M.D., Ashkan Afshari M.D., Stephane Braun M.D., Kent K. Higdon M.D., Galen Perdikis M.D., Julian Winocour M.D.

Affiliations: Vanderbilt University Medical Center

Corresponding Author: Eva Niklinska

The surgical management of rectovaginal fistulas remains difficult, as they tend to be recurrent and vary widely in location and complexity. We present a case of a 63-year-old woman with a low-lying rectovaginal fistula who initially underwent chemoradiation and a Low Anterior Resection for a low-lying rectal cancer. Her course was uneventful until two years post-operatively, at which time her anastomotic staple line became stenotic with associated bleeding. This was initially addressed by Gastroenterology who executed a dilation and achieved hemostasis with Argon Plasma Coagulation. This remedied the stenosis, however, it was complicated by the formation of a rectovaginal fistula. Due to the low-lying location and its presence in an irradiated field, a transvaginal approach with an interposed gracilis flap was elected for repair.

The procedure in this video demonstrates a lower lip sling suspension technique for isolated marginal mandibular nerve palsy using bidirectional fascia grafts.