Robotically Assisted Total Laparoscopic Supralevator Pelvic Exenteration- Steps to Excision of the Pelvic Viscera.

Abstract

STUDY OBJECTIVE\nIllustrate the key steps involved in performing a supralevator pelvic exenteration robotically DESIGN: Video article SETTING: Tertiary care academic center PATIENTS OR PARTICIPANTS: a patient undergoing pelvic exenteration for uterine leiomyosarcoma INTERVENTIONS: Robotic total supralevator pelvic exenteration MEASUREMENTS AND MAIN RESULTS: The paravesical and pararectal spaces are shown in the video, as well as 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 was created from a segment of small bowel approximately 20 cm from the terminal ileum measuring 15 cm long. The 2 ureters were spatulated and attached to the ileal conduit and a stoma was created. The descending segment of colon was brought up through a separate stoma site on the other side of the abdomen to create the colostomy. Total operating time, including reconstruction with the ileal conduit was 480 minutes. Estimate blood loss was 250ml.\n\n\nCONCLUSION\nA total pelvic exenteration can be safely performed robotically with appropriate understanding of the key steps and anatomical landmarks.