Robotic-Assisted Total Laparoscopic Supralevator Pelvic Exenteration: Steps in Excising the Pelvic Viscera |
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| Affiliation: | 1. Obstetric & Gynecology Department, Guangzhou Medical University, Guangzhou, China (Drs. Z. Guan, J. Liu, and X. Guan);2. Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas (Drs. Bardawil and X. Guan);1. Endoscopy Unit, Centro Gutenberg, Malaga, Spain;2. Hillel Yaffe Medical Center, Technion–Israel Technology Institute, Hadera, Israel;3. Department of Public Health, School of Medicine, Unit of Obstetrics and Gynecology, University of Federico II, Naples, Italy;4. Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, Florida.;1. Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC (Drs. Tyan and Carey);2. Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon (Dr. Taher);3. Department of Surgery, George Washington University, Washington, DC (Dr. Amdur);4. School of Medicine and Health Sciences, George Washington University, Washington, DC (Messersmith, Robinson, and Gu);5. Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, George Washington University, Washington, DC (Drs. Vargas and Moawad);1. Department of Obstetrics and Gynecology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany (Drs. Hornemann, Hoch, and Suetterlin);2. Ethianum Clinic for Plastic, Aesthetic and Reconstructive Surgery, Spine, Orthopedic, Gynecology and Hand Surgery, Heidelberg, Germany (Drs. Hornemann, Germann, and Franz);3. Lutrina Hospital Kaiserslautern, Kaiserslautern, Germany (Dr. Franz). |
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| Abstract: | Study ObjectiveTo illustrate the key steps involved in performing a supralevator pelvic exenteration robotically.DesignPresentation of the steps involved in excising the pelvic viscera during robotic-assisted supralevator pelvic exenteration.SettingTertiary care academic center.PatientsA patient undergoing pelvic exenteration for uterine leiomyosarcoma.InterventionsRobotic total supralevator pelvic exenteration.Measurements and Main ResultsIn this woman undergoing pelvic exenteration for uterine leiomyosarcoma, the paravesical and pararectal spaces are shown, along with important pelvic landmarks, such as the major vessels and the ureters. Once the pararectal and paravesical spaces are identified, the parametrium in between is resected. The posterior dissection is then performed along the filmy presacral space to the level of the coccyx and levator muscles. Anteriorly, the bladder is dissected along the space of Retzius, and the urethra is transected. Once the pelvic organs are separated, the specimen is removed, and reconstruction of the pelvic floor is performed. The ileal conduit is created from a segment of small bowel approximately 20 cm from the terminal ileum measuring 15 cm long. The 2 ureters are spatulated and attached to the ileal conduit, and a stoma is created. The descending segment of colon is brought up through a separate stoma site on the other side of the abdomen to create the colostomy. The total operating time, including reconstruction with the ileal conduit, was 480 minutes, and the estimated blood loss was 250 mL.ConclusionTotal pelvic exenteration can be safely performed robotically with appropriate understanding of the key steps and anatomic landmarks. |
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