Robotic total pelvic exenteration with en bloc pelvic side wall clearance and internal iliac artery resection - a video vignette.

Abstract

This video presents a 72 year old male with an anterior local recurrence of a poorly differentiated mucinous adenocarcinoma following a prior low anterior resection for T3N0 mucinous rectal adenocarcinoma. The original operation was performed at a different institution without neoadjuvant chemo-radiotherapy based on low risk features. The patient subsequently developed a T3N0 mucinous recurrence, at a disease free interval of eight years. CT, MRI and PET staging scans post chemo- radiotherapy demonstrated involvement of the right internal iliac artery, representing potential side wall involvement. The current case demonstrates a robotic total pelvic exenteration (TPE) with en bloc right internal iliac artery resection and pelvic side wall clearance. The right internal iliac vein and lumbosacral trunk were preserved. The total operating time was eight hours. The postoperative recovery was uneventful, with no transfusion requirements and the patient was discharged home on day 8 post-exenteration. Final histopathology analysis revealed a completely excised poorly differentiated mucinous adenocarcinoma, with clear margins. An incidental finding of a completely excised acinar-type prostate adenocarcinoma was also found. This case demonstrates the advantages of the robotic platform, such as the clear 3D visualisation of key structures and the use of articulated instruments. Additionally, it highlights how robotic TPE with side wall clearance and internal iliac artery resection en bloc may be performed safely.