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Laparoscopic assisted resection of a ilio-sacral chondrosarcoma: A single case report

INTRODUCTION: Sacral tumor often involves en bloc surgical resection with tumor-free margins and functional reconstruction challenges. Such a management is challenging because of difficulties in accessing the lesion, risks for damages of neighboring organs, and risks for massive blood loss. In poste...

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Autores principales: Possover, Marc, Uehlinger, Kurt, Ulrich Exner, G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064397/
https://www.ncbi.nlm.nih.gov/pubmed/24862027
http://dx.doi.org/10.1016/j.ijscr.2014.04.007
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author Possover, Marc
Uehlinger, Kurt
Ulrich Exner, G.
author_facet Possover, Marc
Uehlinger, Kurt
Ulrich Exner, G.
author_sort Possover, Marc
collection PubMed
description INTRODUCTION: Sacral tumor often involves en bloc surgical resection with tumor-free margins and functional reconstruction challenges. Such a management is challenging because of difficulties in accessing the lesion, risks for damages of neighboring organs, and risks for massive blood loss. In posterior approach, because first elevation of the sacrum allows dissection of presacral structures, such risks for damages intrapelvic structures and hemorrhage are especially high. PRESENTATION OF CASE: We report here about a laparoscopic assisted posterior resection of a ilio-sacral chondrosarcoma in a women, 6 weeks after vaginal delivery. Primary laparoscopic approach consisted in dissection of the ureter and of the colon with control to the pelvic vessels and nerves and determination of limits of the resection. The iliac osteotomy was performed from posterior approach with saw and osteotomes at the predetermined extralesional level. The defect was replaced with a structural fresh frozen femoral allograft and stabilization performed by lumbo-ischial screw/rod fixation. DISCUSSION: Surgical time was about 360 min. No intra-postoperative complications occurred. Blood loss was estimated to about 1000 cm(3). Histologic examination of the specimen showed tumor-free margins. At 8 months follow-up, the patient appears to be without recurrence. Because of the denervation of the nerve root L5 and below, she mostly uses two canes, but she has a functioning quadriceps. Continence and voiding functions for urine and stool have fully recovered. CONCLUSION: Primary laparoscopic approach appeared to be a good way for preparation orthopedics sacroiliac resection to reduce postoperative morbidity, intraoperative blood loss and better assure macroscopic tumor-free margins.
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spelling pubmed-40643972014-06-23 Laparoscopic assisted resection of a ilio-sacral chondrosarcoma: A single case report Possover, Marc Uehlinger, Kurt Ulrich Exner, G. Int J Surg Case Rep Article INTRODUCTION: Sacral tumor often involves en bloc surgical resection with tumor-free margins and functional reconstruction challenges. Such a management is challenging because of difficulties in accessing the lesion, risks for damages of neighboring organs, and risks for massive blood loss. In posterior approach, because first elevation of the sacrum allows dissection of presacral structures, such risks for damages intrapelvic structures and hemorrhage are especially high. PRESENTATION OF CASE: We report here about a laparoscopic assisted posterior resection of a ilio-sacral chondrosarcoma in a women, 6 weeks after vaginal delivery. Primary laparoscopic approach consisted in dissection of the ureter and of the colon with control to the pelvic vessels and nerves and determination of limits of the resection. The iliac osteotomy was performed from posterior approach with saw and osteotomes at the predetermined extralesional level. The defect was replaced with a structural fresh frozen femoral allograft and stabilization performed by lumbo-ischial screw/rod fixation. DISCUSSION: Surgical time was about 360 min. No intra-postoperative complications occurred. Blood loss was estimated to about 1000 cm(3). Histologic examination of the specimen showed tumor-free margins. At 8 months follow-up, the patient appears to be without recurrence. Because of the denervation of the nerve root L5 and below, she mostly uses two canes, but she has a functioning quadriceps. Continence and voiding functions for urine and stool have fully recovered. CONCLUSION: Primary laparoscopic approach appeared to be a good way for preparation orthopedics sacroiliac resection to reduce postoperative morbidity, intraoperative blood loss and better assure macroscopic tumor-free margins. Elsevier 2014-04-28 /pmc/articles/PMC4064397/ /pubmed/24862027 http://dx.doi.org/10.1016/j.ijscr.2014.04.007 Text en © 2014 The Authors http://creativecommons.org/licenses/by-nc-nd/3.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).
spellingShingle Article
Possover, Marc
Uehlinger, Kurt
Ulrich Exner, G.
Laparoscopic assisted resection of a ilio-sacral chondrosarcoma: A single case report
title Laparoscopic assisted resection of a ilio-sacral chondrosarcoma: A single case report
title_full Laparoscopic assisted resection of a ilio-sacral chondrosarcoma: A single case report
title_fullStr Laparoscopic assisted resection of a ilio-sacral chondrosarcoma: A single case report
title_full_unstemmed Laparoscopic assisted resection of a ilio-sacral chondrosarcoma: A single case report
title_short Laparoscopic assisted resection of a ilio-sacral chondrosarcoma: A single case report
title_sort laparoscopic assisted resection of a ilio-sacral chondrosarcoma: a single case report
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064397/
https://www.ncbi.nlm.nih.gov/pubmed/24862027
http://dx.doi.org/10.1016/j.ijscr.2014.04.007
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