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Chapter-33 Role of laparoscopy in advanced pelvic cancers

BOOK TITLE: Minimally Invasive Gynecologic Surgery: Evidence-Based Laparoscopic, Hysteroscopic and Robotic Procedures

Author
1. Kumar Sanjay
2. Agarwal-Joshi Geetanjali
3. Puntambaker Shailesh P
4. Mookim Neha
5. Vashishth Rahul
6. Joshi Saurabh N
7. Puntambaker Seema S
ISBN
9781909836099
DOI
10.5005/jp/books/12892_34
Edition
1/e
Publishing Year
2016
Pages
6
Author Affiliations
1. Lady Hardinge Medical College, New Delhi, India, Bhopal Institute of Gastroenterology
2. Galaxy Care Laparoscopic Institute, Pune, Maharashtra, India, Galaxy Care Laparoscopy Institute, Pune, India
3. Galaxy Care Laparoscopy Institute, Pune, India
4. Galaxy Care Laparoscopy Institute, Pune, India
5. Galaxy Care Laparoscopy Institute, Pune, India
6. Galaxy Care Laparoscopy Institute, Pune, India
7. Galaxy Care Laparoscopy Institute, Pune, India
Chapter keywords
radical hysterectomies, biochemical alterations, ileocecal pouch, rectovaginal fistula, urogenital diaphragm, surgical techniques, postoperative complications, chemotherapy, cutaneous ureterostomy, pathological involvement, abdominal stoma, ureterosigmoidostomy, hyperchloremic acidosis

Abstract

This chapter discusses role of laparoscopy in advanced pelvic cancers, where pelvic exenteration is a radical procedure performed for locally advanced cancers. Supralevator pelvic exenteration is a modification of pelvic exenteration where pelvic organs are excised at the level of the levator muscles, preserving the lowest portion of the rectum and the urogenital diaphragm. In patients with urethral involvement, creation of a continent neobladder cannot be performed. Laparoscopic total pelvic exenteration is a feasible procedure in the management of patients with advanced cervical carcinoma selected carefully. The feasibility of laparoscopic total pelvic exenteration procedure defines newer limits for the use of laparoscopy in gynecological cancers. Anterior exenteration in advanced pelvic tumors offers good quality of life, especially with current methods of urinary diversion. Posterior exenteration includes the removal of the uterus, as well as the rectum with or without establishment of colorectal continuity. Posterior exenteration can also be performed with palliative intent.

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