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Sacrectomy via the abdominal approach during pelvic exenteration
Michael J Solomon1, Ker-Kan Tan, Richard Gideon Bromilow
11Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia 2Surgical Outcomes Research Centre (SOuRCe), Central Sydney Area Health Service, Sydney, New South Wales, Australia 3University of Sydney, Sydney, New South Wales, Australia.
Transabdominal low sacrectomy offers a feasible alternative to the prone position for pelvic exenteration, potentially improving access and vascular control. This technique avoids intraoperative patient repositioning for sacral resections.
Area of Science:
- Surgical Oncology
- Pelvic Surgery
- Oncologic Procedures
Background:
- Sacrectomy is crucial for achieving negative margins in pelvic exenterations.
- The prone position, commonly used for sacrectomy, has limitations in accessing lateral pelvic structures and achieving optimal vascular control.
- A combined abdominolithotomy approach offers superior access and vascular control compared to the prone position.
Purpose of the Study:
- To describe a transabdominal technique for low sacrectomy (below the sacroiliac joint).
- To avoid intraoperative patient repositioning to the prone position.
- To present a novel approach for pelvic exenteration requiring sacrectomy.
Main Methods:
- A two-phase approach: abdominal and perineal.
- Abdominal phase: mobilization of pelvic sidewalls and neurovascular bundles.
- Perineal phase: detachment of posterior sacral attachments, with transabdominal osteotome completion of sacrectomy.
Main Results:
- The described transabdominal technique for low sacrectomy is technically feasible.
- This approach allows for extensive mobilization of pelvic structures.
- Sacrectomy is completed via a transabdominal osteotome, incorporating key ligaments and the pelvic floor.
Conclusions:
- Transabdominal low sacrectomy is a viable surgical option.
- This technique offers practical advantages over the traditional prone approach for low sacrectomy.
- It may enhance surgical outcomes in pelvic exenteration involving the lower sacrum.
