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Laparoscopic pelvic sling placement facilitates optimum therapeutic radiotherapy delivery in the management of pelvic malignancy.
Joyce, M Thirion, P Kiernan, F Byrnes, C Kelly, P Keane, F Neary, P
Joyce, M
Thirion, P
Kiernan, F
Byrnes, C
Kelly, P
Keane, F
Neary, P
Advisors
Editors
Other Contributors
Date
2012-02-01T10:49:55Z
Date Submitted
Keywords
Other Subjects
Subject Mesh
Aged
Cystectomy
Disease Progression
Humans
Intestine, Small/radiation effects
Laparoscopy/*methods
Male
Middle Aged
Postoperative Care
Prostatectomy
Prostatic Neoplasms/*radiotherapy/surgery
Radiation Dosage
Radiation Injuries/*prevention & control
Radiotherapy, Adjuvant/methods
Salvage Therapy/*methods
*Suburethral Slings
Surgical Mesh
Urinary Bladder Neoplasms/*radiotherapy/surgery
Cystectomy
Disease Progression
Humans
Intestine, Small/radiation effects
Laparoscopy/*methods
Male
Middle Aged
Postoperative Care
Prostatectomy
Prostatic Neoplasms/*radiotherapy/surgery
Radiation Dosage
Radiation Injuries/*prevention & control
Radiotherapy, Adjuvant/methods
Salvage Therapy/*methods
*Suburethral Slings
Surgical Mesh
Urinary Bladder Neoplasms/*radiotherapy/surgery
Planned Date
Start Date
Collaborators
Principal Investigators
Alternative Titles
Publisher
Abstract
BACKGROUND: Radiotherapy has a significant role in the management of pelvic malignancies. However, the small intestine represents the main dose limiting organ. Invasive and non-invasive mechanical methods have been described to displace bowel out of the radiation field. We herein report a case series of laparoscopic placement of an absorbable pelvic sling in patients requiring pelvic radiotherapy. METHODS: Six patients were referred to our minimally invasive unit. Four patients required radical radiotherapy for localised prostate cancer, one was scheduled for salvage localised radiotherapy for post-prostatectomy PSA progression and one patient required adjuvant radiotherapy post-cystoprostatectomy for bladder carcinoma. All patients had excessive small intestine within the radiation fields despite the use of non-invasive displacement methods. RESULTS: All patients underwent laparoscopic mesh placement, allowing for an elevation of small bowel from the pelvis. The presence of an ileal conduit or previous surgery did not prevent mesh placement. Post-operative planning radiotherapy CT scans confirmed displacement of the small intestine allowing all patients to receive safely the planned radiotherapy in terms of both volume and radiation schedule. CONCLUSION: Laparoscopic mesh placement represents a safe and efficient procedure in patients requiring high-dose pelvic radiation, presenting with unacceptable small intestine volume in the radiation field. This procedure is also feasible in those that have undergone previous major abdominal surgery.
Language
eng
ISSN
1532-2157 (Electronic)
0748-7983 (Linking)
0748-7983 (Linking)
eISSN
ISBN
DOI
10.1016/j.ejso.2008.01.035
PMID
18358678