Robotic pelvic sidewall resection with en bloc sciatic nerve excision – a video vignette.

Abstract

Video S1 demonstrates the novel technique of robotic pelvic sidewall excision with sciatic nerve resection for recurrent rectal cancer. The patient had previously undergone an ultralow anterior resection with total mesorectal excision at another hospital. We describe our technique, highlighting anatomically important structures. (available via subscription).

Video S1 shows the technique of utilizing ureteric catheters with indocyanine green to clearly visualize urological structures, and also shows the technique required for a robotic common iliac artery and vein mobilization, ligation of the internal iliac artery and vein, pelvic sidewall excision, with en bloc redo colonic conduit removal, excision of the lumbosacral trunk and S2/3 nerve roots and complete excision of the involved sciatic nerve with underlining piriformis muscle whilst preserving the obturator nerve for function.

A radical pelvic sidewall excision comes with high morbidity. Our total blood loss was 200 ml, and we demonstrate restoration of intestinal continuity and preservation of the urinary bladder here. We also demonstrate residual leg function with this selective nerve resection approach, while still achieving an R0 resection. Posterior nerve resection in the pelvic sidewall is possible robotically, and this is the first experience to be described in the literature.