| Summary: | This video is a guide to minimally invasive partial excision of the levator ani muscle (PELM) with coloanal anastomosis in patients with low rectal cancer in whom there is unilateral involvement of the levator ani. In the past, rectal cancer with invasion of the levator muscle represented an indication for abdominoperineal resection with permanent colostomy. With recent advances in understanding of the anatomy of the anorectum and pelvic floor, however, it has become possible to preserve the anal sphincter in cases of ipsilateral levator ani involvement. The video explains the relevant surgical anatomy and shows how to perform minimally invasive PELM, describing transabdominal and perineal procedures step by step. In addition, functional and oncologic outcomes are presented, based on the author's personal experiences. It is anticipated that this novel technique will become one surgical treatment option among the various anal sphincter-saving procedures.
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