Step-by-step demonstration of “sciatic-nerve-preserved beyond- LEER” in a Thiel-embalmed cadaver: a novel salvage surgery for recurrent gynecologic malignancies

다국어 초록 (Multilingual Abstract)

Objective: Complete resection is the curative treatment choice for recurrent gynecologicalmalignancies. Laterally extended endopelvic resection (LEER) is an effective surgical salvagetherapy for lateral recurrence. However, when a recurrent tumor occupies the ischial spineand sacrum, LEER is not indicated, and surgical salvage therapy is abandoned. Theoretically,complete resection of such a tumor is possible by additional pelvic bone resection alongwith the standard LEER. Nevertheless, owing to the anatomical complexities of the beyond-LEER procedure, 2 major issues should be solved: sciatic nerve injury and tumor disruptionduring pelvic bone amputation. To overcome these technical challenges, we applied amultidirectional beyond-LEER approach, a novel salvage surgical procedure, with an aim ofdemonstrating its technical feasibility.
Methods: We created a simulation model of a laterally recurrent tumor that occupied theright ischial spine and sacrum in a Thiel-embalmed cadaver.
Results: Multidirectional approaches, including laparoscopic, perineal, and dorsal phases,were safely applied. We laparoscopically marked the L4-L5-S1 complex and S2 nerve withdifferent colored tapes, and by pulling them out into a dorsal surgical field, the sciatic nervewas safely preserved. The dissection lines of the multidirectional approaches were alignedusing tapes as landmarks, and complete tumor clearance without tumor disruption wasaccomplished. By following the cadaveric training, the first laparoscopic-assisted beyond-LEER procedure was successfully performed in a patient with recurrent ovarian cancer.
Conclusion: Using a Thiel-embalmed cadaver, we demonstrated the technical feasibility ofa sciatic nerve-preserved beyond-LEER procedure, which was successfully performed in apatient with recurrent ovarian cancer.