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Summary

Robotic-assisted total pelvic exenteration (TPE) is a feasible minimally invasive surgery for recurrent cervical cancer in Jehovah's Witnesses. This approach allows for complex multi-organ resection even after prior treatments.

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Area of Science:

Minimally invasive surgery
Surgical oncology
Robotic surgery

Background:

Recurrent cervical cancer poses complex surgical challenges.
Robotic-assisted total pelvic exenteration (TPE) offers a minimally invasive alternative for extensive pelvic operations.
Managing Jehovah's Witness patients requires careful consideration of transfusion avoidance strategies.

Observation:

A 70-year-old Jehovah's Witness with recurrent cervical cancer post-chemoradiation and hysterectomy underwent robotic TPE.
The procedure involved detailed exploration, mobilization of pelvic structures, and en bloc resection of involved organs.
Reconstruction included pelvic floor repair with mesh and omental flap, along with creation of ileal conduit and colostomy.

Findings:

Final pathology confirmed recurrent squamous cell carcinoma involving vaginal, bladder, and rectal walls.
Surgical margins and regional lymph nodes were negative for malignancy.
The robotic TPE was successfully completed without blood transfusions.

Implications:

Robotic-assisted TPE is technically feasible and safe for Jehovah's Witness patients with recurrent cervical cancer.
This approach can be effectively utilized in patients with prior pelvic radiation and surgery.
Multidisciplinary surgical teams are crucial for managing complex cases requiring transfusion avoidance.