Laparoscopic Posterior Pelvic Exenteration (Complete and Supralevator) for Locally Advanced Adenocarcinoma of the Rectum in Females: Surgical Technique and Short-Term Outcomes

Pokharkar, Ashish; Bankar, Sanket; Rohila, Jitender; Jaiswal, Dushyant; Desouza, Ashwin; Saklani, Avanish

doi:10.1089/lap.2019.0691

Cited by 12 publications

(9 citation statements)

References 11 publications

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“…8 Also, laparoscopic resection for beyond and extended total mesorectal excision is performed with good short-term outcomes. 9,10 Owing to complete lockdown, when there is a shortage of blood supply, laparoscopic surgery will be advantageous as it gives minimal blood loss, decreased ward stay, and minimum intervention by staff for dressing and monitoring.…”

Section: Discussionmentioning

confidence: 99%

The Technique and Justification for Minimally Invasive Surgery in COVID-19 Pandemic: Laparoscopic Anterior Resection for Near Obstructed Rectal Carcinoma

Pawar

Pokharkar

Gori

et al. 2020

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Introduction:The recent COVID-19 pandemic outbreak has made surgeons change and take on newer strategies and safe exercises. All elective cases have been put off, but oncology cases need to be done to prevent progression of the disease. There is concern about minimally invasive surgery due to aerosol formation. Here we discuss how we have dealt with this in our colorectal surgery department taking into account current evidence about the danger of viral transmission during laparoscopic surgery. Discussion: We report a case of 28 years old female patient with carcinoma rectum. The patient had near total intestinal obstruction. She was operated on utilizing laparoscopic anterior resection. The air seal (CONMED, Utica, NY) and high-efficiency particulate air (HEPA) filter was utilized for safe gas evacuation. There is no evidence against laparoscopic surgery, which suggest viral transmission. One should take utmost precautions using N95 masks and personal protective equipment (PPE). Air filtration products like aerosol, HEPA filters will be of great aid in safe evacuation of gases. Conclusion: At present, there is no solid evidence to suggest viral transmission through surgical smoke. We believe due to effective smoke containment, less blood loss, and less postoperative stay, laparoscopy will be a non-inferior option than open surgical procedure. We advise taking all precautions for operating room staff to lessen the danger of transmission.

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Section: Discussionmentioning

confidence: 99%

The Technique and Justification for Minimally Invasive Surgery in COVID-19 Pandemic: Laparoscopic Anterior Resection for Near Obstructed Rectal Carcinoma

Pawar

Pokharkar

Gori

et al. 2020

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“…Dear Editor, The COVID-19 pandemic has focused surgeons and healthcare systems on the hazards of minimally invasive surgery and its devices [1,2]. Energy and articulating laparoscopic and robotic instruments contain hollow spaces in their shafts and handles to allow cabling to transmit electrical energy to the instrument tip and tissue.…”

Section: Supporting Informationmentioning

confidence: 99%

“…The pathological examination showed invasive endometriosis and no evidence of malignancy.There are a few cases of pelvic exenteration performed for invasive endometriosis [1]. Laparoscopic posterior exenteration is a complex and rarely done procedure [2]. The aim of this video (Video S1 in the online Supporting Information) is to demonstrate this procedure for locally advanced lesions of the rectum or uterus.…”

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confidence: 99%

A combined robotic approach to a synchronous upper rectal and prostate cancer – a video vignette

et al. 2020

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We present the case of a 45-year-old woman with an 8month history of abdominal pain and haematochezia. Colonoscopy and biopsy showed rectal endometriosis. Abdominal CT and MRI revealed multiple uterine fibroids, and the anterior wall of rectum was invaded. The patient suffered from severe anaemia requiring blood transfusion. A posterior pelvic exenteration for palliation of symptoms and for tissue diagnosis was recommended by the multidisciplinary team. Ultimately, the patient underwent laparoscopic supralevator posterior pelvic exenteration in a joint effort by the departments of gastrointestinal surgery and gynaecological oncology. The operating time was 265 min, with an estimated blood loss of 100 ml. The patient was discharged home on postoperative day 8 without complications. The pathological examination showed invasive endometriosis and no evidence of malignancy. There are a few cases of pelvic exenteration performed for invasive endometriosis [1]. Laparoscopic posterior exenteration is a complex and rarely done procedure [2]. The aim of this video (Video S1 in the online Supporting Information) is to demonstrate this procedure for locally advanced lesions of the rectum or uterus. Conflicts of interest There are no conflicts of interest to declare. Author contributions LX contributed to the conception of the study. YS contributed significantly to manuscript preparation. CL directed manuscript preparation. HZ produced the video and wrote the manuscript. All authors read and approved the final manuscript.

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“…With the high volume of rectal cancers presenting to the colorectal unit, rigorous multidisciplinary team (MDT) evaluation and regular MRI use, our surgical practice has evolved significantly. This enables us to offer laparoscopic resections even for high-risk locally advanced rectal cancers [17][18][19][20]. However, considering the concerns raised in recent trials [6,7] about the oncological safety of laparoscopic rectal cancer surgery and the different tumour profile seen in our centre, it was necessary to analyse our practice critically.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic versus open resection in locally advanced rectal cancers: a propensity matched analysis of oncological and short‐term outcomes

Sasi

Kammar

Sivasanker³

et al. 2021

Colorectal Disease

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Aim:The aim was to compare oncological and short-term outcomes between open and laparoscopic surgery in locally advanced rectal cancers.Methods: It is a retrospective analysis conducted in a high volume tertiary centre.Matching was carried out for nine variables, including preoperative factors, neoadjuvant treatment and sphincter preservation. Results:Both the open and laparoscopic surgery arms had 239 patients each. The distributions of pretreatment MRI T3, T4, circumferential resection margin (CRM) positive tumours, neoadjuvant long-course chemoradiation and sphincter preservation were 80.3%, 13.6%, 50%, 89% and 56.4% respectively. The mean number of nodes harvested (12.9 vs. 12.7, P = 0.716), pathological CRM positivity (6.3% in open vs. 5.4% in laparoscopic, P = 0.697) and distal resection margins were similar. The mean blood loss was higher in open surgeries (910 ml vs. 349 ml, P < 0.001). Anastomotic leaks and Clavien-Dindo Grade 3-4 complications were higher in the open arm than in the laparoscopy arm (5.9% vs. 1.7%, P = 0.024, and 12.5% vs. 6.7%, P = 0.015 respectively). The median postoperative hospital stay was significantly shorter in the laparoscopy arm (7 vs. 6, P = 0.015). In CRM positive and threatened cases, the measured outcomes were similar between the two groups except for blood loss which was significantly higher in the open surgery (872 vs. 379, P = 0.000). Conclusions: In high volume centres, in the hands of experienced colorectal surgeons, laparoscopic rectal surgery is oncologically safe in locally advanced rectal cancers and has lesser morbidity and shorter hospital stay than open surgery. In CRM positive and threatened cases the laparoscopic surgery showed less blood loss compared to open surgery, while other outcome measures were similar to open surgery.

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Laparoscopic Posterior Pelvic Exenteration (Complete and Supralevator) for Locally Advanced Adenocarcinoma of the Rectum in Females: Surgical Technique and Short-Term Outcomes

Cited by 12 publications

References 11 publications

The Technique and Justification for Minimally Invasive Surgery in COVID-19 Pandemic: Laparoscopic Anterior Resection for Near Obstructed Rectal Carcinoma

The Technique and Justification for Minimally Invasive Surgery in COVID-19 Pandemic: Laparoscopic Anterior Resection for Near Obstructed Rectal Carcinoma

A combined robotic approach to a synchronous upper rectal and prostate cancer – a video vignette

Laparoscopic versus open resection in locally advanced rectal cancers: a propensity matched analysis of oncological and short‐term outcomes

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