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LAPAROSCOPIC TOTAL PELVIC EXENTERATION USING A LINEAR STAPLER FOR URETHRAL AND DORSAL VEIN COMPLEX TRANSECTION

Akihiro Kondo1, Yuji Nishizawa2, Hiroshi Taketani1, Naoki Yamamoto1, Takahisa Fujita1. 1Takamatsu Hospital, 2National Cancer Center Hospital East

INTRODUCTION: Total pelvic exenteration (TPE) is an invasive operation for the management of advanced low rectal cancer. Laparoscopic surgery offers intra- and postoperative benefits even in patients with advanced low rectal cancer requiring TPE. However, dorsal vein complex (DVC) and urethral transection during TPE are time-consuming and technically challenging procedures associated with a high rate of hemorrhage. This study aimed to show the use of a linear stapler for DVC and urethral transection during laparoscopic TPE. We have additionally assessed the surgical benefit of this method.

METHODS AND PROCEDURES: An 85-year-old man with advanced low rectal cancer and suspected prostatic invasion underwent laparoscopic TPE. After medial-to-lateral retroperitoneal dissection and division of the inferior mesenteric artery, posterior dissection was performed to the level of the levator ani muscle. The bilateral ureters were mobilized and divided at the level of the ureterovesical junction. Anteriorly, the Retzius and the paravesical spaces were exposed to the level of the endopelvic fascia. Bilateral dissection was performed along the internal iliac vessels, and branches from these vessels were divided. After dissection of the endopelvic fascia, the levator ani muscle, and the ischiorectal fossa using a combined abdominal and perineal approach the DVC and urethra were completely exposed. Finally, en bloc transection of the DVC and urethra was performed using a linear stapler that was inserted from the perineal aspect. The specimen was extracted through the abdominal incision. After primary closure of the perineal wound, we constructed the ileal conduit and an endo-sigmoidostomy.

RESULTS: The DVC and the urethra were easily transected without significant bleeding, and the operative procedure was relatively less time consuming. Total operating time was 513 min and estimated blood loss was 629 mL. Postoperatively, he developed pelvic dead space infection; however, he responded to conservative treatment.

CONCLUSION: DVC and urethral transection using a linear stapler could be a simple and useful method associated with minimal bleeding during laparoscopic TPE performed for advanced low rectal cancer.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 91723

Program Number: P312

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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