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Robotic-Assisted Total Pelvic Exenteration

  • Peter C. LimEmail author
  • Elizabeth Y. Kang
Chapter

Abstract

Total pelvic exenteration is an ultra-radical procedure which involves removal of pelvic organ content and reconstruction of urinary system, gastrointestinal, and pelvic floor. Brunschwig in 1948 was the first to describe the procedure [1]. This ultra-radical surgery typically requires a large incision in an operative field that is small and deep. In addition, the tissues are commonly distorted, obliterated, or fibrotic either from previous surgical dissection and/or radiation. Thus, the development of surgical planes can be challenging. Consequently, this procedure is associated with long operative time, high morbidity, prolonged hospitalization, and mortality. Minimally invasive surgery offers several advantages over open surgery including shorter hospitalization, faster recoveries, less blood loss, better cosmesis, and fewer complications. In order to decrease morbidity and prolonged hospitalization, a minimally invasive approach might be an alternative to laparotomy for pelvic exenteration.

Supplementary material

Video 22.1

Robotic-assisted supralevator total pelvic exenteration (MP4 117429 kb)

Video 22.2

Robotic-assisted intracorporeal posterior pelvic exenteration (MP4 65505 kb)

Video 22.3

Robotic-assisted total intracorporeal ileal conduit (MP4 55290 kb)

Video 22.4

Robotic-assisted total intracoporeal colorectal anastomosis (MP4 25101 kb)

References

  1. 1.
    Brunschwig A. Complete excision of pelvic viscera for advanced carcinoma; a one-stage abdominoperineal operation with end colostomy and bilateral ureteral implantation into the colon above the colostomy. Cancer. 1984;1(2):177–83.CrossRefGoogle Scholar
  2. 2.
    Pomel C, Rouzier R, Pocad M, et al. Laparoscopic total pelvic exenteration for cervical cancer relapse. Gynecol Oncol. 2003;91:616–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Lim PC. Robotic assisted total pelvic exenteration: a case report. Gynecol Oncol. 2009;115(2):310–1.CrossRefPubMedGoogle Scholar
  4. 4.
    Lim PC, Kang E, Park DH. A comparative detail analysis of the learning curve and surgical outcome for robotic hysterectomy with lymphadenectomy versus laparoscopic hysterectomy with lymphadenectomy in treatment of endometrial cancer: a case-matched controlled study of the first one hundred twenty two patients. Gynecol Oncol. 2011;120(3):413–8.  https://doi.org/10.1016/j.ygyno.2010.11.034.CrossRefPubMedGoogle Scholar
  5. 5.
    Seamon LG, Fowler JM, Richadson DL, et al. A detailed analysis of the learning curve: robotic hysterectomy and pelvic-aortic lymphadenectomy for endometrial cancer. Gynecol Oncol. 2009;114(2):162–7.  https://doi.org/10.1016/j.ygyno.2009.04.017.CrossRefPubMedGoogle Scholar
  6. 6.
    Lim PC, Kang E, Park DH. Learning curve and surgical outcome for robotic-assisted hysterectomy with lymphadenectomy: case-matched controlled comparison with laparoscopy and laparotomy for treatment of endometrial cancer. J Minim Invasive Gynecol. 2010;17(6):739–48.  https://doi.org/10.1016/j.jmig.2010.07.008.CrossRefPubMedGoogle Scholar
  7. 7.
    Lim PC, Kang EK. How to prepare the patient for robotic surgery: before and during the operation. Best Pract Res Clin Obstet Gynaecolo. 2017. pii: S1521-6934(17)30066-4. doi:https://doi.org/10.1016/j.bpobgyn.2017.04.008
  8. 8.
    Magrina JF, Stanhope CR, Weaver AL. Pelvic exenterations: supralevator, infralevator, and with vulvectomy. Gynecol Oncol. 1997;64(1):130–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Chalmers D, Cusano A, Haddock P, et al. Are preexisting retinal and central nervous system-related comorbidities risk factors for complications following robotic-assisted laparoscopic prostatectomy? Int Braz J Urol. 2015;41(4):661–8.  https://doi.org/10.1590/S1677-5538.IBJU.2014.0464.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Morrow CP, Curtin JP. Gynecologic cancer surgery. 1st ed. New York: Churchill Livingstone; 1996. p. 534–77.Google Scholar
  11. 11.
    Pedersen J, Song DH, Selber JC. Robotic, intraperitoneal harvest of the rectus abdominis muscle. Plast Reconstr Surg. 2014;134(5):1057–63.  https://doi.org/10.1097/PRS.0000000000000586.CrossRefPubMedGoogle Scholar
  12. 12.
    Rutledge FN, Smith JP, Wharton JT, et al. Pelvic exenteration: analysis of 296 patients. Am J Obstet Gynecol. 1977;129(8):8811–92.CrossRefGoogle Scholar
  13. 13.
    Morley GW, Hopkins MP, Lindenauer SM, et al. Pelvic exenteration, University of Michigan: 100 patients at 5 years. Obstet Gynecol. 1989;74(6):934–43.PubMedGoogle Scholar
  14. 14.
    Goldberg GL, Sukumvanich P, Einstein MH, et al. Total pelvic exenteration: the Albert Einstein College of Medicine/Montefiore Medical Center experience (1987 to 2003). Gynecol Oncol. 2006;101(2):261–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Ramamurthy R, Durainpandian A. Morbidity and outcome of pelvic exenteration in locally advanced pelvic malignancies. Indian J Surg Oncol. 2012;3(3):231–5.  https://doi.org/10.1007/s13193-012-0129-3.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Maggino A, Roviglione G, Landoni F, et al. Pelvic exenteration: ten-year experience at the European Institute of Oncology in Milan. Gynecol Oncol. 2009;114(1):64–8.  https://doi.org/10.1016/j.ygyno.2009.03.029.CrossRefGoogle Scholar
  17. 17.
    Jäger L, Nilsson PJ, Rådestad AF. Pelvic exenteration for recurrent gynecologic malignancy: a study of 28 consecutive patients at a single institution. Int J Gynecol Cancer. 2013;23(4):755–62.  https://doi.org/10.1097/IGC.0b013e318287a874.CrossRefPubMedGoogle Scholar
  18. 18.
    Petruzziello A, Kondo W, Hatschback SB, et al. Surgical results of pelvic exenteration in the treatment of gynecologic cancer. World J Surg Oncol. 2014;12:279.  https://doi.org/10.1186/1477-7819-12-279.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Moreno-Palacios E, Diestro MD, De Santiago J, et al. Pelvic exenteration in gynecologic cancer: La Paz University Hospital experience. Int J Gynecol Cancer. 2015;25(6):1109–13.  https://doi.org/10.1097/IGC0000000000000435.CrossRefPubMedGoogle Scholar
  20. 20.
    Davis MA, Adams S, Eun D, et al. Robotic-assisted laparoscopic exenteration in recurrent cervical cancer robotics improved the surgical experience for 2 women with recurrent cervical cancer. Am J Obstet Gynecol. 2010;202(6):663.e1.  https://doi.org/10.1016/j.ajog.2010.04.004.CrossRefPubMedGoogle Scholar
  21. 21.
    Puntambekar S, Lawande A, Desai R, et al. Initial experience of robotic anterior pelvic exenteration at a single institute. Int J Gynaecol Obstet. 2014;126(1):41–4.  https://doi.org/10.1016/j.ijgo.2013.12.015.CrossRefPubMedGoogle Scholar
  22. 22.
    Lim PC, Kang EY (2011) Early experience of robotic pelvic exenteration compared to pelvic exenteration for treatment of gynecological malignancy. In: 17th International meeting of the European Society of Gynecological Oncology, 11–14 September 2011.Google Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Center of HopeUniversity of Nevada School of MedicineRenoUSA

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