Ioannis T Konstantinidis1, William Chu2, Federico Tozzi1, Clayton Lau2, Mark Wakabayashi3, Kevin Chan2, Byrne Lee4. 1. Division of Surgical Oncology, Department of General Surgery, City of Hope National Cancer Center, Duarte, CA, USA. 2. Division of Urologic Oncology, Department of General Surgery, City of Hope National Cancer Center, Duarte, CA, USA. 3. Division of Gynecologic Oncology, Department of General Surgery, City of Hope National Cancer Center, Duarte, CA, USA. 4. Division of Surgical Oncology, Department of General Surgery, City of Hope National Cancer Center, Duarte, CA, USA. bylee@coh.org.
Abstract
BACKGROUND: Robotic-assisted total pelvic exenteration (TPE) can offer a minimally invasive approach to a major multi-organ operation. METHODS: In this video, we summarize a stepwise approach to robotic TPE in a 70 year-old female Jehovah's witness with a history of cervical cancer post-chemoradiation and radical hysterectomy who experienced local recurrence at the vaginal cuff involving the rectum and bladder. RESULTS: The patient was placed in the lithotomy position. A total of six robotic ports were used and the da Vinci Si robotic system was docked between the legs. We proceeded as follows: (1) the abdomen and pelvis were thoroughly explored for evidence of metastatic disease; (2) the pelvic sidewalls were mobilized and bilateral ureters identified; (3) the mesorectal plane was dissected to the level of the levators; (4) the lateral and anterior pelvic structures were completely mobilized, and parametrial tissues were mobilized to the pelvic wall; (5) the bladder was separated from the pubis symphysis, the space of Retzius entered, and the bladder and proximal urethra freed; (6) a perineal incision was made around the vagina, perineal body, and anus, which were excised; (7) an Alloderm mesh secured the pelvic floor, and an omental J flap was mobilized; and (8) a 6 cm incision was utilized for creation of an ileal conduit and a permanent-end colostomy. Final pathology was consistent with recurrent cervical squamous cell carcinoma invading into the vaginal, bladder, and rectal walls. Surgical margins and seven lymph nodes were negative for carcinoma. CONCLUSION: Robotic-assisted TPE is technically feasible in a Jehovah's witness under a multidisciplinary surgical team, even in the setting of prior radical hysterectomy and irradiated tissue.
BACKGROUND: Robotic-assisted total pelvic exenteration (TPE) can offer a minimally invasive approach to a major multi-organ operation. METHODS: In this video, we summarize a stepwise approach to robotic TPE in a 70 year-old female Jehovah's witness with a history of cervical cancer post-chemoradiation and radical hysterectomy who experienced local recurrence at the vaginal cuff involving the rectum and bladder. RESULTS: The patient was placed in the lithotomy position. A total of six robotic ports were used and the da Vinci Si robotic system was docked between the legs. We proceeded as follows: (1) the abdomen and pelvis were thoroughly explored for evidence of metastatic disease; (2) the pelvic sidewalls were mobilized and bilateral ureters identified; (3) the mesorectal plane was dissected to the level of the levators; (4) the lateral and anterior pelvic structures were completely mobilized, and parametrial tissues were mobilized to the pelvic wall; (5) the bladder was separated from the pubis symphysis, the space of Retzius entered, and the bladder and proximal urethra freed; (6) a perineal incision was made around the vagina, perineal body, and anus, which were excised; (7) an Alloderm mesh secured the pelvic floor, and an omental J flap was mobilized; and (8) a 6 cm incision was utilized for creation of an ileal conduit and a permanent-end colostomy. Final pathology was consistent with recurrent cervical squamous cell carcinoma invading into the vaginal, bladder, and rectal walls. Surgical margins and seven lymph nodes were negative for carcinoma. CONCLUSION: Robotic-assisted TPE is technically feasible in a Jehovah's witness under a multidisciplinary surgical team, even in the setting of prior radical hysterectomy and irradiated tissue.
Authors: Rogier M P H Crolla; Janneke J C Tersteeg; George P van der Schelling; Jan H Wijsman; Jennifer M J Schreinemakers Journal: Surg Endosc Date: 2018-05-16 Impact factor: 4.584
Authors: Stefano Cianci; Martina Arcieri; Giuseppe Vizzielli; Canio Martinelli; Roberta Granese; Marco La Verde; Anna Fagotti; Francesco Fanfani; Giovanni Scambia; Alfredo Ercoli Journal: Front Surg Date: 2021-11-30
Authors: Barbara L Smith; Conor R Lanahan; Michelle C Specht; Bridget N Kelly; Carson Brown; David B Strasfeld; Jorge M Ferrer; Upahvan Rai; Rong Tang; Travis Rice-Stitt; Anna Biernacka; Elena F Brachtel; Michele A Gadd Journal: Ann Surg Oncol Date: 2020-01-02 Impact factor: 5.344