Figure 3. Intraoperative images of the perineal approach for the en-bloc tumor resection. (A) View of the introitus at the beginning of the operation. The caudal end of the tumor is visible on the left side of the introitus (yellow circle). (B) The tumor is being resected, first by dissecting it off the posterior vaginal wall and the pelvic floor on both sides. The external urethral orifice and the anterior vaginal wall are visible. (C) After resection of the tumor off the posterior vaginal wall, a retraction system is placed. The anus is closed by sutures. (D) En-bloc resection of the tumor together with the anus and rectum. The rectum has already been positioned outside of the pelvis (yellow arrow).