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| Name | V13-03: Robot-Assisted Total Pelvic Exenteration: Indications and Technical Considerations |
| Video Uploader | Video From AUAUniversity |
| Upload Date | This Video Uploaded At 05-10-2021 17:18:26 |
| Video Discription | V13-03: Robot-Assisted Total Pelvic Exenteration: Indications and Technical Considerations in Urological Surgery Authors: Sonpreet Rai, Ramesh Thurairaja, Shamim Khan, Mark George, Alexis Schizas, Rajesh Nair Introduction: Robot-Assisted Total Pelvic Exenteration (RA-TPE) represents extremis-multi-disciplinary extirpative surgery for advanced and complex pelvic pathology. Within urological practice, the indications are rare and include complex benign pathology, locally advanced or recurrent pelvic malignancy or in circumstances where bowel or urinary reconstruction is not feasible or fraught with complication. Increasing familiarity with robotics have facilitated the option of Robot-Assisted TPE being considered with increasing frequency. We present indications and technical considerations from our series based at a tertiary level referral centre Methods: : Indications and technical consideration for a RA-TPE are defined. To aid those considering embarking on this procedure, it is broken into ten key steps. Critical to the procedure is the management of the rectum and urinary diversion which are defined. Three options are provided for management of the rectum depending on the presenting pathology, patient disease characteristics and pre-conditioned comorbid state. Results: The technical steps of the procedure are divided into robotic access and docking; ureteric identification and athermal dissected; mobilization of the sigmoid colon and division of the inferior rectal artery; development of the total mesorectal excision (TME) plane; division of the lateral bladder pedicles; anterior bladder wall mobilisation and radical prostatectomy; management of the rectal stump subdivided into: (i) Abdominoperineal resection with excision of the perineum +/- mesh repair; (ii) Stapling with rectal stump; (iii) mucous fistula (wet colostomy); ileal conduit urinary diversion; colostomy and urostomy formation; closure and post-operative enhanced recovery care. Conclusions: RA-TPE is an extirpative surgical option for advanced and complex pelvic pathology. It harnesses the advantages of minimally invasive surgery and can be safely employed for complex urological benign pelvic pathology, locally advanced or recurrent pelvic malignancy or in circumstances where bowel or urinary reconstruction is not advocated. Source of Funding: Not applicable |
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