24: Total supralevator pelvic exenteration: steps to excision of the pelvic viscera

Abstract

Demonstrate the steps of a total robotic pelvic exenteration and illustrate the key anatomical landmarks involved in a pelvic exenteration. This video illustrates the key steps involved in performing a supralevator pelvic exenteration robotically, with understanding of the key anatomical landmarks. 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. A total pelvic exenteration can be safely performed robotically with appropriate understanding of the key steps and anatomical landmarks.