Initial experience of laparoscopic pelvic exenteration and comparison with conventional open surgery

Uehara, K.; Nakamura, Hayato; Yumura, Yasushi; Arimoto, Atsuki; Kato, Takehiro; Yokoyama, Yukihiro; Ebata, Tomoki; Nagino, Masato

doi:10.1007/s00464-015-4172-3

Cited by 45 publications

(48 citation statements)

References 27 publications

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“…[32] compared perioperative outcomes of laparoscopic pelvic exenteration (n = 13) with open approach (n = 18), and results were similar to those of Uehara et al [29] . The estimated blood loss (930 vs. 3003 mL; P = 0.001) and total volume of blood transfusion (0 vs. 1990 mL; P = 0.002) were significantly lower in patients undergoing laparoscopic pelvic exenteration compared with those undergoing open pelvic exenteration.…”

Section: Ogura Et Almentioning

confidence: 74%

“…Relative contraindications include extension of tumor through the sciatic notch, encasement of external iliac vessels -requiring en bloc resection and/or reconstruction of external iliac vessels, high sacral involvement (above S2/S3), and predicted R2 resection. Patients who underwent multiple laparotomies and predicted to have severe small bowel adhesion are precluded from having MIS [29] . Initial experience in laparoscopic pelvic exenteration was reported in few case reports and video vignette [28,30] .…”

Section: Pelvic Exenterationmentioning

confidence: 99%

“…One of the initial experiences of laparoscopic pelvic exenteration come from Uehara et al [29] . They discussed the technical points of laparoscopic pelvic exenteration and compared the short-term results of laparoscopic pelvic exenteration with those of conventional open pelvic exenteration.…”

Section: Pelvic Exenterationmentioning

confidence: 99%

“…The surgeon performed posterior and lateral pelvic wall dissection in the initial part of surgery and anterior dissection in the last phase to avoid suspension of urinary bladder. Dissection along internal iliac vessels and identification and transection of small branches are important to avoid intraoperative bleeding [29] . The dorsal vein complex was clipped and divided using bipolar soft-coagulation of a VIO system.…”

Section: Pelvic Exenterationmentioning

confidence: 99%

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Minimal invasive approach for beyond total mesorectal excision/extended resections in rectal cancer

Kumar¹,

Kammar²,

Saklani³

2018

MIS

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Minimal invasive surgery (MIS) is an accepted modality of treatment for rectal cancer. The indications for MIS have gradually been extended to locally advanced and locally recurrent rectal cancer as a result of technological advances in instrumentation, advances in surgical techniques, increased surgeon experience, and high volume center. However, safety and feasibility of laparoscopic surgery and robotic surgery in beyond total mesorectal excision (b-TME) and extended TME (e-TME) are not well established. This review summarizes the current evidence for MIS approach for b-TME/extended resections in rectal cancer. A systematic search was carried out in PubMed. Studies available in English related to MIS approach in b-TME/e-TME in rectal cancers were identified and evaluated. This review concludes MIS is feasible with good perioperative outcomes in b-TME/e-TME in carefully selected patients. Laparoscopic surgery has considerable learning curve and should be performed by experienced surgical teams. Robotic surgery is feasible and beneficial in complex resection in pelvis. However, evidence for long-term oncological outcomes of MIS in b-TME/e-TME is low and needs to be studied further by randomized controlled trial once enough numbers are possible in institutes with high volume rate.

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Section: Ogura Et Almentioning

confidence: 74%

Section: Pelvic Exenterationmentioning

confidence: 99%

Section: Pelvic Exenterationmentioning

confidence: 99%

Section: Pelvic Exenterationmentioning

confidence: 99%

See 2 more Smart Citations

Minimal invasive approach for beyond total mesorectal excision/extended resections in rectal cancer

Kumar¹,

Kammar²,

Saklani³

2018

MIS

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mentioning

confidence: 99%

Laparoscopic pelvic sidewall dissection with combined resection of internal iliac vessels for local recurrence of rectal cancer

et al. 2015

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Pelvic sidewall dissection with combined resection of the internal iliac vessels is an important procedure that is sometimes required in advanced pelvic surgery [1][2][3]. However, it is a technically demanding procedure because of the complex anatomy of the iliac vessels, especially the iliac vein, in relation to the surrounding structures. Here, we demonstrate our method of laparoscopic pelvic sidewall dissection combined with resection of the distal internal iliac.We present a video of laparoscopic pelvic sidewall dissection for recurrent rectal cancer following laparoscopic abdominoperineal resection (APR). The patient was a 66-year-old man with a body mass index (BMI) of 23.5 kg/m 2 . He had local recurrence of rectal cancer at the left pelvic sidewall. Five ports were used ( Fig. 1). After the isolation of the ureter, dissection along the pelvic sidewall was started. Then, the anterior compartment containing the obturator nodes was dissected from the lateral side of the vesicohypogastric fascia [4,5]. A dissectible layer between the pedicle of the internal iliac vessels and the sciatic plexus/piriformis muscle was entered from the lateral side, and the internal iliac vessels were mobilized toward the midline. Sufficient mobilization of the internal iliac vessels facilitates safe isolation and division of the vessels while avoiding injury to the sacral nerves posteriorly. The neurovascular bundle was divided at the side of the prostate, and lastly, the inferior gluteal and pudendal vessels were divided at the inferior sciatic foremen using an endoscopic linear stapler and the specimen was extracted.We performed pelvic sidewall dissection with combined resection of internal iliac vessels for local recurrence of rectal cancer on three patients (one male and two females). One patient underwent combined APR resection of the rectum. No patient had a medical comorbidity. Median (range) values for age, BMI, operative time, and intraoperative blood loss in this series were 67 (51-69) years, 22.1 (20.1-23.5) kg/m 2 , 322 (294-614) min, and 92 (0-152) g, respectively. Pathological examination revealed metastatic adenocarcinoma with negative margins. There were no deaths and no major (Cgrade 3 of the Clavien-Dindo classification) intraoperative or postoperative complications. No patient had motor or urinary dysfunction. Two patients had recurrence (liver and peritoneal).Our technique of laparoscopic pelvic sidewall dissection combined with resection of iliac vessels appears to be safe, and we believe that the patients benefit from the minimally invasive approach.Electronic supplementary material The online version of this article (

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Minimally Invasive Pelvic Exenteration

Collins

Kontovounisios

Tekkis

2021

Surgical Management of Advanced Pelvic Cancer

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Initial experience of laparoscopic pelvic exenteration and comparison with conventional open surgery

Cited by 45 publications

References 27 publications

Minimal invasive approach for beyond total mesorectal excision/extended resections in rectal cancer

Minimal invasive approach for beyond total mesorectal excision/extended resections in rectal cancer

Laparoscopic pelvic sidewall dissection with combined resection of internal iliac vessels for local recurrence of rectal cancer

Minimally Invasive Pelvic Exenteration

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