Laparoscopic Pelvic Exenteration with Radical Vaginectomy Using 3-Dimensional Vision and Multifunction Instrument

Study Objective The video article describes a laparoscopic anterior pelvic exenteration with radical vaginectomy using the 3-dimensional (3D) vision and multifunction instruments. Methods This is a step-by-step video presentation of the laparoscopic anterior pelvic exenteration (Canadian Task Force classification III). Although the therapeutic benefit of the PE remains controversial, it is often performed in women with centrally recurrent pelvic tumors that previously received radiation therapy or in the locally advanced cases (ie, stage IIb-IVa) resistant to radiochemotherapy. The patient was a 61-year-old woman (body mass index 31.8 kg/m²) with locally advanced squamous cervical cancer involving the bladder (International Federation of Gynecology and Obstetrics stage IVa) submitted to chemoradiotherapy with no response and was admitted for surgery. The preoperative positron emission tomography/computed tomography scan was negative for metastatic localizations. The surgery was performed including radical hysterectomy, cystectomy, and colpectomy with macroscopic resection margins larger than 2 cm; a subsequent Bricker's ileal conduit was completed. An Endoeye Flex 3D Videoscope (Olympsus System) and Thunderbeat device were used to perform it. Results The operation was performed successfully with no intraoperative or postoperative complications. Total duration of surgery was 330 minutes. The estimated blood loss was 100 mL. The patient was discharged on day 8. The pathology report was positive for relapse of cervical cancer (tumor diameter = 4 cm) with infiltration of the vagina and the posterior bladder's muscle. Conclusions Laparoscopic anterior pelvic exenteration with radical colpectomy using 3D vision and multifunction instrument is a fast and safe procedure. However, we notice that further prospective trials are needed to compare this technique with other open surgery and minimally invasive approach (ie, robotically).