Laparoscopically assisted vulvocolpohysterectomy and abdominoperineal resection with sigmoid vaginal replacement.

BACKGROUND

In this report, we discuss the feasibility of laparoscopy for the resection of recurrent invasive vulvar cancer involving the vagina and anus (stage IVA), requiring radical surgical treatment.

METHODS

Successive steps of surgery are discussed: laparoscopic mobilization of the uterus, colon, and rectum for a posterior compartment exenteration (radical vulvectomy, colpohysterectomy, and abdominoperineal resection) and primary neovaginal reconstruction with sigmoid vaginal replacement.

RESULTS

Duration of surgery was 240 minutes. There was no postoperative complication except for a small dehiscence of the perineal wound that healed completely without intervention. The patient was discharged 10 days after surgery. One month after surgery, coloplasty showed a good perineal opening and a depth of 12 cm. Minimal prolapse of the mucous of the coloplasty and abundant secretion could be observed. Adjuvant radiotherapy was indicated.

CONCLUSIONS

This combination of laparoscopic techniques is a potential alternative for exenteration or abdominoperineal resection requiring vaginal reconstruction.