VM67 - Robotic En Bloc Abdominoperineal Resection, Hysterectomy, and Partial Vaginectomy with Rectus Abdominus Myocutaneous Flap Vaginal Reconstruction

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Video Presentation(s)

LQ

Luis A. Quintero, MD

Resident
Memorial Healthcare System
Plantation, Florida, United States

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Author(s)

Tamara V. Damrel, MD

General Surgery Resident
Memorial Healthcare System
Hollywood, FL, United States

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BR

Betsy Rodriguez, DO (she/her/hers)

Surgery Resident
Memorial Hospital System
HMH- Palisades Medical Center
Dania Beach, FL, United States

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This individual has no financial relationships with ineligible companies.
Natalie Ceballos, MD

General Surgery Resident
Memorial Healthcare System
Memorial Healthcare System
Pembroke Pines, FL, United States

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This individual has no financial relationships with ineligible companies.
JH

Jennifer Hernandez, MD

General Surgery Resident
Memorial Healthcare System
Hollywood, Florida, United States

Disclosure information not submitted.
Hayley M. Carroll, MD

Surgical Resident
Memorial Healthcare System
Plantation, FL, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
JL

Jason Levine, MD

Plastic Surgeon
Plastic Surgery Specialists of South Florida
Hollywood, Florida, United States

Disclosure information not submitted.
JB

Jonathan Black, MD, MPH

Physician/Surgeon
Memorial Hospital System
Miramar, Florida, United States

Disclosure information not submitted.

Senior Author(s)

MD

Michael E. Dolberg, MD FACS FASCRS

Colorectal surgeon
Memorial Healthcare System
Davie, Florida, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Luis A. Quintero, MD: This individual has no financial relationships with ineligible companies.

Tamara V. Damrel, MD: This individual has no financial relationships with ineligible companies.

Betsy Rodriguez, DO: This individual has no financial relationships with ineligible companies.

Natalie Ceballos, MD: This individual has no financial relationships with ineligible companies.

Hayley M. Carroll, MD: This individual has no financial relationships with ineligible companies.

Michael E. Dolberg, MD FACS FASCRS: This individual has no financial relationships with ineligible companies.

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Purpose/Background: This is a case of a 40-year-old female with a history of T4N1 low rectal adenocarcinoma s/p Total Neoadjuvant Therapy (TNT), a robotic ultralow anterior resection with intracorporeal coloanal anastomosis and laparoscopic loop ileostomy, subsequent loop ileostomy reversal, who 1 year later developed recurrence at coloanal anastomosis with a colovaginal fistula.

Methods/Interventions: She underwent a robotic abdominoperineal resection with en bloc resection of the uterus, fallopian tubes, ovaries, and the posterior wall of the vagina. As well as a right vertical rectus abdominis myocutaneous flap for posterior vaginal reconstruction and end colostomy.

Results/Outcomes: The patient recovered well post-operatively. The final pathology revealed invasive moderately differentiated adenocarcinoma consistent with recurrent rectal adenocarcinoma arising from coloanal anastomosis and involving the posterior vaginal wall. All margins of resection are negative for carcinoma. No lymphovascular invasion identified.

Conclusion/Discussion: Herein we discuss the complexity of a robotic resection of rectal cancer recurrence at the coloanal anastomosis with vaginal involvement requiring reconstruction with rectus abdominis muscle flap. The case highlights the importance of a multidisciplinary surgical approach with colorectal surgery, gynecology oncology, and plastic surgery for improved outcomes. There are few cases reported in the literature. This video presentation showcases the capabilities of robotic surgery in this unique case.