Robotic total pelvic exenteration for locally advanced rectal cancer – a video vignette

Kammar, Praveen; Bakshi, Ganesh; Verma, Kamlesh; Sugoor, Pavan; Saklani, Avanish

doi:10.1111/codi.14256

Cited by 8 publications

(6 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 14 – 15 We have also standardized the technique of robotic TPE ( Figure 2 ). 16 The steps of the abdominal part of surgery included retroperitoneal dissection (medial to lateral), inferior mesenteric artery and vein division, retrorectal space dissection all the way down to the origin of the levator ani muscle, medialization of the ureters, dissection of the pararectal and paravesical spaces up to the endopelvic fascia, retzius space dissection, division of the dorsal venous complex, transection of the urethra, division of the ureters, and transection of the sigmoid colon. 9 The LPLND technique was also described previously, 17 which included ureteric medialization, dissection around the iliac vessels, obliterated umbilical artery dissection, obturator nerve identification, and a radical dissection up to the pelvic floor to complete the standard template.…”

Section: Methodsmentioning

confidence: 99%

“…We used standard port placement as used for TPE. 14 – 16 Our technique of robotic posterior exenteration was published recently. 18 The initial steps of surgery until dissection of the retro-rectal space were similar to MIS TPE.…”

Section: Methodsmentioning

confidence: 99%

“… 10 We regularly perform exenterative surgeries, extended resections and multivisceral resections for CRC cases. 11 – 13 Our initial experience with regard to laparoscopic exenteration 14 – 15 and the techniques of robotic exenteration 16 – 18 were published previously. 9 There were only a few studies, which had compared MIS with open PE (OPE).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Minimally Invasive Surgery for Pelvic Exenteration in Primary Colorectal Cancer

Kumar

Sasi

Shinde

et al. 2020

JSLS

View full text Add to dashboard Cite

Background: Minimally invasive surgery (MIS) for pelvic exenteration is not a well-established technique. The aim was to assess the safety and feasibility of MIS for pelvic exenteration in locally advanced primary colorectal cancer and to compare the perioperative outcomes with open surgery. Methods: This is a retrospective analysis of patients, who had undergone pelvic exenteration for primary colorectal adenocarcinoma from May 2013 to July 2018. The shortterm outcomes like perioperative details and histopathological characteristics were compared between the two groups. Results: MIS was performed in 23 patients and open pelvic exenteration was carried out in 72 patients. The mean operative time was significantly more in the MIS group (640 vs. 432 min, p ϭ 0.00). The intraoperative blood loss (900 vs. 1550 ml, p ϭ 0.00) and the requirement for blood transfusion (170 vs. 250 ml, p ϭ 0.03) was significantly less in the MIS group. The overall morbidity (60% vs. 49%, p ϭ 0.306) was comparable between the two groups. The median length of hospital stay in the MIS group was 11 d, compared to 12 d in the open surgery group, (p ϭ 0.634). The rate of R0 resection (87% vs. 89%, p ϭ 0.668) was comparable between the two groups. Conclusion: MIS is feasible and safe for total pelvic exenteration and posterior exenteration in carefully selected locally advanced primary colorectal cancer, when performed by an experienced surgical team in high volume centers. An R0 resection with adequate margin can be achieved with good perioperative outcomes in MIS. Long-term oncological outcomes would require further follow up to confirm.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Minimally Invasive Surgery for Pelvic Exenteration in Primary Colorectal Cancer

Kumar

Sasi

Shinde

et al. 2020

JSLS

View full text Add to dashboard Cite

show abstract

“…Minimally invasive surgery is being practised at high‐volume centres, and its role in the management of locally advanced rectal cancers is still evolving [1]. A few video vignettes are available demonstrating the technique of robotic total pelvic exenteration [2]. The complications of creating a conduit or a neobladder as a urinary diversion in a patient undergoing total pelvic exenteration for locally advanced rectal cancer range from recurrent urinary infection and electrolyte imbalance to renal failure.…”

mentioning

confidence: 99%

Abdominoperineal excision with prostatectomy in T4 rectal cancer – bladder‐sparing robotic pelvic exenteration – a video vignette

et al. 2020

Self Cite

View full text Add to dashboard Cite

colic insertion (Fig. 3). An articulating linear stapler (EziSurg Medical Co., Shanghai, China), introduced through the D-Port, was used to section the sigmoid colon just below the circular anvil (Fig. 4). The rectal stump was closed by a laparoscopic transanal pursestring suture, keeping the spike of the anvil in the centre of the suture. The circular stapler was introduced transanally and a side-to-end anastomosis was performed. The anastomosis was finally checked by contrast-enhanced indocyanine green perfusion (Video S1 in the online Supporting Information). The operating time required for the described step was 93 min. The postoperative course was uneventful, and the patient was discharged after 6 days. At followup, no anastomotic complications were recorded. Different colorectal anastomoses can be performed during TaTME. The technique described here can be considered as one of the laparoscopic options.

show abstract

“…As experience grows with the robotic platform, pushing the surgical boundaries for better patient outcomes is natural. We have previously published our standardized techniques of total pelvic exenteration and pelvic node dissection in locally advanced rectal cancers . Anterior and anterolaterally advanced disease in female patients requires posterior exenteration for clear margins.…”

mentioning

confidence: 99%