Laterally-Extended Endopelvic Resection (LEER) of recurrent epithelioid trophoblastic tumor by laparoscopy

We report the resection of a recurrent epithelioid trophoblastic tumor by laparoscopic Laterally-Extended Endopelvic Resection (LEER). The LEER technique was developed to resect en bloc multiple visceral compartments involving the lateral pelvic wall with negative margins for local control of advanced and recurrent malignancies. Described by Höckel, this procedure is usually performed by a midline laparotomy.Our patient had undergone prior laparotomic surgery including hysterectomy, partial bladder resection and a right ureteral re-implantation for an epithelioid trophoblastic tumor without adjuvant treatment. She presented a recurrent tumor infiltrating the bladder, the ureter and the right pelvic wall as well as internal and external iliac vessels.A vascular surgeon first performed a femoro-femoral bypass by bilateral groin incisions with subcutaneous tunnel. The surgery was then exclusively performed by laparoscopy using the LEER technique including resection of both external and internal iliac vessels, the pelvic wall through the lateral pelvic muscles, and iterative bladder resection associated with a ureteral re-implantation using the psoas hitch bladder technique. The patient experienced Clavien-Dindo classification grade II postoperative complications. Histology showed a margin-free resection (R0).
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research