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Total sacrectomy technique using Gigli saws

Total sacrectomy technique using Gigli saws.

Sacrectomy is a complex and delicate surgical procedure that involves the total or partial removal of the sacrum bone, which is the lower part of the spine located between the lumbar spine and the coccyx. This bone plays a fundamental role in the body’s support structure and the stability of the pelvic region.

There are several reasons why a sacrectomy may be necessary. For example, in cases of malignant bone tumors or severe traumatic injuries, such as severe sacral fractures, partial or total removal of the sacrum bone may be necessary to avoid further complications and alleviate pain.

Sacrectomy is a highly specialized surgical intervention, requiring a multidisciplinary team of orthopedic surgeons, neurosurgeons, oncologists, among other healthcare professionals. The surgical approach may vary depending on the extent of sacrum bone removal and the underlying condition of the patient.

During the procedure, it is essential to ensure the preservation of nearby nerve structures, such as the sacral nerves, to minimize the risk of neurological complications and preserve the function of the lower limbs and bowel and bladder.

After sacrectomy, rehabilitation is a crucial part of the recovery process. Patients typically undergo physiotherapy and occupational therapy to aid in the recovery of mobility and adaptation to potential changes in musculoskeletal function.

Although sacrectomy is a complex surgery with significant risks and challenges, it can be vital for improving quality of life and prolonging survival in cases of severe conditions affecting the sacrum bone. It is essential for patients to receive close monitoring and specialized care before, during, and after the procedure to optimize outcomes and minimize complications.

Let’s describe the video of the conference presented at Mount Sinai Hospital – Toronto, May 25, 2011.

Summary

Video 1 of the first part of the total sacrectomy technique for treating tumor lesions. This technique uses Gigli saws to perform an oncologically safe resection of sacral neoplasms, whether in bone or soft tissue, in the region.

Watch the video part 1 of the sacrectomy technique using Gigli saws.

We will discuss the topic of sacral resection and reconstruction, with a focus on the anterior approach using video laparoscopy.

Total sacrectomy refers to the complete removal of this segment. This procedure typically results in deformities, functional loss, and compromised control of the bladder and anal sphincters.

What are the functions and quality of life for a patient following a total sacrectomy without reconstruction?

We will first demonstrate improvements in the surgical approach for sacral resection, utilizing a Gigli saw as previously presented in this case of a recurrent giant cell tumor (GCT) of the sacrum after the third surgery involving intralesional curettage.

We plan to perform a total sacrectomy using both anterior and posterior approaches to achieve an oncological resection.

 To perform this procedure, two osteotomies will be made on the iliac bone, and a third will be made below the L5 vertebra.

 To minimize bleeding during these pelvic osteotomies in spongy bone, we perform an anterior intra-abdominal approach and ligate the internal iliac vessels (arteries and veins) before positioning the three Gigli saws. Two are placed through the sciatic notch and the iliac crest, and the third below the level of the L5 vertebra.

 To facilitate the placement of the Gigli saws from the inside of the pelvic cavity to the dorsal region of the patient, a cushion should be placed under the pelvis and sacrum. This cushion will be removed during the surgery, allowing the surgeon to easily pull out the saws afterwards.”       

The patient is positioned supine in a gynecological position for either a transperitoneal or retroperitoneal anterior approach. In this case, we isolate the vessels and nerves and use a puncture through the sciatic notch to place the saws.

Gigli saws should be sheathed in a plastic tube, such as a catheter, which is then passed through this metal tube and exits through the back. This diagram illustrates the passage of the saws at the level of L5-S1, through the posterior portion of the right and left iliac bones. An X-ray is then performed to verify the correct positioning of the saws.

Once the saw is positioned, the anterior approach is closed, and the patient is repositioned prone. We can then see the saws on their back. The posterior approach is commenced, and all osteotomies are performed as shown in this diagram. This results in an en bloc resection.

Here we are performing the osteotomy using the saws through the posterior approach. Hemostasis has been achieved, and the resection of the sacrum is performed according to this schema. We performed an “en bloc resection.”

Postoperative X-rays confirm the total resection of the sacrum.

The patient has started bed-based physiotherapy and will remain on a tilt table for eight weeks to train for orthostatic tolerance.

After this training, the patient will begin exercises on parallel bars and walking with Canadian crutches. After about three months, the patient is able to walk with the aid of crutches.

This technique has been enhanced with the use of video laparoscopy.

Video of the second part of sacrectomy, with the assistance of videolaparoscopy, coming soon on this channel! 

Check out the video of the lecture

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