Abstract
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After endotracheal intubation, catheterize the patient and then position in a prone jack-knife position, with the shoulders and pelvis being supported by rolled towels (Fig. 1).
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Make an inverted V-shaped or chevron incision, with the apex being lower sacrum or sacrococcygeal junction and extending dorsolaterally on either side of the tumour (Fig. 2). Deepen the incision to reach the tumour capsule.
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Raise skin flaps to expose the tumour completely.
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Dissect the tumour from the inferior and medial aspects of the gluteus maximus muscles to visualize the sacrum and coccyx.
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Transect the coccyx at the sacrococcygeal joint. Just anterior to the anterior cortex of the bone, the median sacral vessels are visualized, ligated and divided. Thereafter dissect and ligate collateral tumour blood supply originating from the lateral sacral vessels (Fig. 3).