Laparoscopic hand-assisted Miami Pouch after pelvic exenteration in 10 steps

Abstract

BackgroundImprovements in surgical technique of pelvic exenteration have mainly occurred in the reconstructive phase of the procedure. Quality of life seems to be improved when performing continent rather than non-continent urinary diversion [1]. Unfortunately, Miami continent urinary pouch is a surgical technique not frequently used among surgeons. MethodsThis video illustrates the creation of a laparoscopic hand-assisted Miami Pouch in 10 consecutive steps. We present the case of a patient with an isolated central pelvic recurrence of cervical cancer who underwent a laparoscopic anterior pelvic exenteration, which is not included in the film. The surgery was performed by an experienced oncological surgeon in a French comprehensive cancer center. ResultsWe split the surgical technique in the 10 following steps:1.Trocar placement2.Right colon and ureteral mobilization3.Preparation of omental J-flap for pelvic filling and vaginal reconstruction4.Placement of circumferential retractor through a minilaparotomic incision5.Right colon and ileum transection followed by restoration of intestinal continuity6.Detubularization of the right colon7.Bilateral ureteral stent insertion and anastomosis to colonic mucosa8.Pouch closure and ileum tapering9.Exteriorization of ureteral stents and pouch fixation to abdominal wall10.Minilaparotomy closure and urostomy fixation ConclusionsMiami Pouch is a urinary reconstructive procedure that can improve quality of life after pelvic exenteration. As it has been previously reported, this film illustrates the feasibility of laparoscopic hand-assisted Miami Pouch after laparoscopic anterior pelvic exenteration [2,3]. A step-by-step comprehensive standardization of surgical techniques shortens learning curve of training surgeons [4]. [Display omitted]