Beyond TME—Robotic bladder preserving pelvic exenteration: A video vignette

Accurate radiological staging, focused multi-disciplinary team work and improved preoperative treatment regimens have expanded surgical boundaries in the treatment of rectal cancer. Pelvic exenteration is an umbrella term for a multitude of operative techniques. The terms used vary across disciplines and between the units. To overcome this a pelvic lexicon has been introduced which allows a broader understanding of the bespoke nature of such surgery and an in-depth description of, the components of extended pelvic resection in the corresponding compartments (Video 1). In a conventional total pelvic exenteration we complete presacral TME mobilization, drop the bladder and enter the Space of Retzius, perform cystoprostatectomy, and complete the perineum. The salient steps of bladder-preserving pelvic exenteration have been illustrated here. In beyond TME—bladder-sparing pelvic resection, we begin with presacral TME, enter the Denonvilliers fascia, divide the vas, define the seminal vesicle, following which bladder drop is performed, prostatectomy is performed and bladder is spared. Gomathi Meenakshi Periyasamy: Conceptualization; investigation; funding acquisition; writing – original draft; methodology; validation; visualization; writing – review and editing; software; formal analysis; project administration; resources; supervision; data curation. Syed Althaf: Conceptualization; investigation; methodology; validation; visualization; formal analysis; project administration; supervision; resources; funding acquisition. Srinivas Chunduri: Supervision; resources; data curation; formal analysis; validation; methodology; funding acquisition. Pavan Sugoor: Conceptualization; investigation; funding acquisition; writing – original draft; writing – review and editing; visualization; validation; methodology; software; formal analysis; project administration; resources; supervision; data curation. This video received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors have no conflicts of interest to declare. All co-authors have seen and agree with the contents of the manuscript and there is no financial interest to report. We certify that the submission is original work and is not under review at any other publication. Ethics committee approval was not sought for this procedure, as this procedure is part of a routine protocol in our surgical oncology department. Informed consent was taken from the patient. The data that support the findings of this study are available from the corresponding author upon reasonable request.