Laparoscopically assisted vulvocolpohysterectomy and abdominoperineal resection with sigmoid vaginal replacement.

摘要

BACKGROUND: In this report, we discuss the feasibility of laparoscopy for the resection of recurrent invasive vulvar cancer involving the vagina and anus (stage IVA), requiring radical surgical treatment. METHODS: Successive steps of surgery are discussed: laparoscopic mobilization of the uterus, colon, and rectum for a posterior compartment exenteration (radical vulvectomy, colpohysterectomy, and abdominoperineal resection) and primary neovaginal reconstruction with sigmoid vaginal replacement. RESULTS: Duration of surgery was 240 minutes. There was no postoperative complication except for a small dehiscence of the perineal wound that healed completely without intervention. The patient was discharged 10 days after surgery. One month after surgery, coloplasty showed a good perineal opening and a depth of 12 cm. Minimal prolapse of the mucous of the coloplasty and abundant secretion could be observed. Adjuvant radiotherapy was indicated. CONCLUSIONS: This combination of laparoscopic techniques is a potential alternative for exenteration or abdominoperineal resection requiring vaginal reconstruction.