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PurposeTumors at the level of the anorectal junction had required APR to achieve an adequate resection margin. However, in the cases of tumor invading ipsilateral levator-ani muscle (LAM), en bloc resection of the rectum with LAM including tumor would be possible. This video is to show the critical anatomic steps of this procedure.MethodsA video was produced from the robotic right 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 nCRT.ResultsThe patient discharged at POD #8 without complication. The pathology of the surgical specimen revealed ypT3N1bM0. The secure resection margin from the tumor was achieved.ConclusionRobotic 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 abdominoperineal resection (APR) or extralevator APR.

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