First in Literature Intraneuronal Sacral Nerve Stimulation for Fecal Incontinence After Robotic-Assisted En-Bloc Sacrectomy with Transection of Nerve Roots

TY - JOUR

T1 - First in Literature Intraneuronal Sacral Nerve Stimulation for Fecal Incontinence After Robotic-Assisted En-Bloc Sacrectomy with Transection of Nerve Roots

AU - Melling, Nathaniel

AU - Scognamiglio, Pasquale

AU - Teller, Sven

AU - Izbicki, Jakob Robert

AU - Dreimann, Marc

AU - Perez, Daniel

N1 - Copyright © 2020 Elsevier Inc. All rights reserved.

PY - 2020/4

Y1 - 2020/4

N2 - BACKGROUND: En-bloc sacrectomy is the treatment of choice for patients affected by sacral chordoma. It is a radical surgical procedure, which has to face the problem of handling fragile anatomic structures, such as the internal iliac vessels and the sacral nerve roots, with the risk of causing bowel, bladder, and sexual dysfunction. The combined anterior-posterior approach allows for a safer dissection of the tumor from the mesorectal fascia than the mere posterior approach, especially for tumors extending proximally to S3. Robotic surgery can improve the safety of the procedure. Sacral nerve stimulation is an accepted therapeutic option for fecal incontinence and may be used to treat postoperative incontinence.CASE PRESENTATION: We report on a patient affected by sacral chordoma with en-bloc sacrectomy preceded by a robotic-assisted dissection of the mesorectal fascia and on managing the postoperative fecal incontinence by implanting a sacral nerve stimulator on the first postoperative day. To our knowledge this is the first such procedure in the literature.CONCLUSIONS: From our experience, a robotic anterior approach increases safety for the organs in the pelvis when performing a sacrectomy. Moreover, a sacral nerve stimulator should be considered to manage neurologic complications following transection of nerve roots after sacrectomy.

AB - BACKGROUND: En-bloc sacrectomy is the treatment of choice for patients affected by sacral chordoma. It is a radical surgical procedure, which has to face the problem of handling fragile anatomic structures, such as the internal iliac vessels and the sacral nerve roots, with the risk of causing bowel, bladder, and sexual dysfunction. The combined anterior-posterior approach allows for a safer dissection of the tumor from the mesorectal fascia than the mere posterior approach, especially for tumors extending proximally to S3. Robotic surgery can improve the safety of the procedure. Sacral nerve stimulation is an accepted therapeutic option for fecal incontinence and may be used to treat postoperative incontinence.CASE PRESENTATION: We report on a patient affected by sacral chordoma with en-bloc sacrectomy preceded by a robotic-assisted dissection of the mesorectal fascia and on managing the postoperative fecal incontinence by implanting a sacral nerve stimulator on the first postoperative day. To our knowledge this is the first such procedure in the literature.CONCLUSIONS: From our experience, a robotic anterior approach increases safety for the organs in the pelvis when performing a sacrectomy. Moreover, a sacral nerve stimulator should be considered to manage neurologic complications following transection of nerve roots after sacrectomy.

U2 - 10.1016/j.wneu.2019.12.173

DO - 10.1016/j.wneu.2019.12.173

M3 - SCORING: Journal article

C2 - 31917317

VL - 136

SP - 208

EP - 212

JO - WORLD NEUROSURG

JF - WORLD NEUROSURG

SN - 1878-8750

ER -