Pelvic exenteration (pelvic evisceration) was a radical surgical treatment which will involves removes of all organs from the person’s pelvic cavity. The urethra, urinary bladder, rectum, & anus were removed.
The procedure may leave the person with a permanent colostomy & urinary diversion. In women, the vagina, ovaries, uterus, fallopian tubes, cervix, and in some other cases the vulva was also been removed. In men, the prostate was removed.
Pelvic exenteration was most frequently used in certain cases of extremely recurrent or advanced cancer, in which less radical surgical options were not technically possible or could not be sufficient to remove the whole tumor. This method was done for many kinds of the cancer that will include genitourinary & colorectal cancers.
OPEN PELVIC EXENTERATION:
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Doctor will make a few small cuts or incisions, in the abdomen. This will allow the doctor to check the organs inside the peritoneal cavity, the abdominal cavity & the walls of the pelvis and abdomen.
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The doctor will collect tissue samples so that he can be examined under the microscope to see if they contain cancer cells or not.
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During the extenteration, the doctor makes a large incision in the lower abdomen & pelvis. The doctor will observe at the inside of the abdomen to view if there were any signs of cancer in the areas that would prevent surgery from continuing. The doctor will remove or take samples from lymph nodes to observe if they contain cancer or not.
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If the surgeon has a doubt that the tumor can be removed completely, then pelvic exenteration will begins. The doctor will removes the pelvic lymph nodes, reproductive organs and other supporting tissues in the pelvis. The doctor will also remove the bladder, rectum or both. Occasionally part of the colon was also been removed. The surgeon will have to perform another incision in the perineum to remove some of these organs.
LAPROSCOPIC PELVIC EXENTERATION:
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The patient’s bowel is prepared with a purgative & liquid diet.
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General anesthetic induction will be done, broad spectrum antibiotics was administered before keeping the subject in 40 degree trendelenburg position.
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A 5-port transperitoneal laparoscopic total pelvic exenteration was done, with the perineal excision of an anal margin.
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The surgery consisted of an excision of sigma-rectum, bladder and prostate in the man & uterus, ovaries in the woman as a single mass, extracted through the perineal wound, follows by an extracorporeal reconstruction for the urinary diversion through an ileal urostomy & faecal diversion by an end colostomy. The pelvis were irrigated with an aqueous tumourcidal betadine solution.
