IPEG 2018 - LAPAROSCOPIC LIGATION OF MIDDLE SACRAL ARTERY AND DISSECTION OF SACROCOCCYGEAL TERATOMA

Thank you. I'm Gustavo from Saint Louis. Thank you for allowing us to present our work. This video will present two patients that underwent a laparoscopic ligation in the middle sacral artery. The middle sacral artery is the main blood supply of sacrococcygeal teratomas. This vessel has proven to be a major source of morbidity for these cases. The first patient is a 15-month-old girl who presented from an outside institution with buttocks swelling and 4 weeks of constipation. Initial MRI at our institution showed a large pelvic mass. With metastatic disease to the liver. Here you can see her middle sacral artery. Initial AFP was over 60,000, and she completed 6 cycles of chemotherapy. With significant response. We started the operation by placing a percutaneous transuterine suture to allow better visualization of the pelvis. Some initial adhesions were taken down. We began our dissection on the left lateral aspect of the rectal mesentery. Here you can see The area of the sacrum and where the inferior mesenteric artery is located. Following neoadjuvant therapy, her FB had normalized. And continues to be normal after surgery. As we continue our dissection down towards the sacrum, we identify the middle sacral artery. The middle sacral artery was further skeletonized and identified. Using blunt dissection, the middle sacral artery was isolated. The middle sacral artery was sealed and divided. We then directed our attention to the pelvic component of the tumor. Which was further dissected. Since the patient had a total body prep. The patient was then flipped. And the operation was completed in a posterior sagittal approach. Our second patient was a 60-year-old girl who had a prenatally diagnosed sacrococcygeal teratoma. Her initial AFP was 131,000, and after surgery was 8000. Postnatal MRI showed a type 2. Teatoma amenable for resection. Port placement. We began our dissection in a similar fashion as the previous case. After the ureters were identified. Here you can see the common iliac's bifurcating. By continuing our dissection. Between the common iliacs, we were able to identify the middle sacral artery in our neonate. The middle sacral artery was isolated. Controlled, and then divided using sharp scissors. We then turned our attention to dissect the pelvic component of the teratoma. Once this was completed, since the patient had a total body prep, we flipped the patient and we resected the teratoma using a standard chevron incision. Thank you.