V13-03 ROBOT-ASSISTED TOTAL PELVIC EXENTERATION: INDICATIONS AND TECHNICAL CONSIDERATIONS IN UROLOGICAL SURGERY

Abstract

You have accessJournal of UrologyBladder & Upper Tract Urothelial Oncology (V13)1 Sep 2021V13-03 ROBOT-ASSISTED TOTAL PELVIC EXENTERATION: INDICATIONS AND TECHNICAL CONSIDERATIONS IN UROLOGICAL SURGERY Sonpreet Rai, Ramesh Thurairaja, Shamim Khan, Mark George, Alexis Schizas, and Rajesh Nair Sonpreet RaiSonpreet Rai More articles by this author , Ramesh ThurairajaRamesh Thurairaja More articles by this author , Shamim KhanShamim Khan More articles by this author , Mark GeorgeMark George More articles by this author , Alexis SchizasAlexis Schizas More articles by this author , and Rajesh NairRajesh Nair More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002100.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: 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 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1078-e1079 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sonpreet Rai More articles by this author Ramesh Thurairaja More articles by this author Shamim Khan More articles by this author Mark George More articles by this author Alexis Schizas More articles by this author Rajesh Nair More articles by this author Expand All Advertisement Loading ...