Laparoscopic pelvic sling placement facilitates optimum therapeutic radiotherapy delivery in the management of pelvic malignancy.
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.


CONCLUSIONS
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.
Joyce
M
M
Division of Colorectal Surgery, Minimally Invasive Surgery, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland. mylesjoyce@eircom.net
Thirion
P
P
Kiernan
F
F
Byrnes
C
C
Kelly
P
P
Keane
F
F
Neary
P
P
D000368:Aged; D015653:Cystectomy; D018450:Disease Progression; D006801:Humans; D007421:Intestine, Small / Q000528:radiation effects; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000517:prevention & control*; D018714:Radiotherapy, Adjuvant / Q000379:methods; D016879:Salvage Therapy / Q000379:methods*; D053825:Suburethral Slings; D013526:Surgical Mesh; D001749:Urinary Bladder Neoplasms / Q000532:radiotherapy* / Q000601:surgery