Laparoscopic Posterior Pelvic Exenteration with Transvaginal Natural Orifice Specimen Extraction

Abstract

The incidence of tumor invasion of the reproductive system in female patients with rectal cancer has been reported to be as high as 18%. Hence, posterior pelvic exenteration (PPE), which combines the en bloc resection of the rectum, uterus, ovaries, and vagina, is currently a widely accepted treatment option for female patients with rectal cancer and offers patients the only chance to achieve a clinical cure. With the rapid development of laparoscopic techniques, laparoscopic PPE with natural orifice specimen extraction is applicable in female patients who have locally advanced rectal cancer with rectal tumor invasion of the uterus and posterior vaginal wall requiring combined PPE. The operative features of this procedure include transvaginal extraction of the rectum and the invaded uterus or vaginal wall, followed by total laparoscopic end-to-end anastomosis of the sigmoid colon and rectum or Hartmann’s procedure. The approach for transvaginal specimen extraction can avoid auxiliary incision in the abdominal wall and only leaves a few tiny trocar scars on the abdominal wall after the surgery. Therefore, laparoscopic PPE with natural orifice specimen extraction manifests perfect minimally invasive effect, and accelerates postoperative rehabilitation. Notably, only a small proportion of exenteration specimens can be extracted transvaginally. Additional abdominal incisions are still required for large tumors.