• Rua General Jardim, 846 cj 41 Higienópolis, São Paulo - SP

This digital library houses the book on Oncology and Orthopedic Oncosurgery.

It includes academic lectures, presentations from national and international congresses, published papers, case discussions, performed surgical procedures, and proprietary techniques developed.

The digital format was chosen because the web allows the inclusion of texts with numerous visual resources, such as images and videos, which would not be possible in a printed book.

The content is intended for students, healthcare professionals, and the general public interested in the field.

Total sacrectomy without reconstruction – Part I

Total sacrectomy without reconstruction - Part I

Video 1: This technique uses Gigli saws to perform a safe, oncological resection of aggressive malignant or benign tumors, whether they are bone or soft tissue.

Figure 1: Total sacrectomy refers to the complete removal of this segment. This procedure results in: deformity, functional deficit and impaired sphincter, anal and bladder control.
Figure 2: What are the functions and quality of life for a patient after a total sacrectomy without reconstruction?
Figure 3: We will first demonstrate the improvements in the surgical approach for sacral resection, using Gigli saws, as presented in this case resection of a recurrent Giant Cell tumor of the sacrum, after the third attempt at surgical treatment, involving an intralesional curettage. We plan to perform a total sacrectomy, using a double approach (anterior and posterior), in order to achieve an oncological resection.
Figure 4: To perform this procedure, two osteotomies will be made in the iliac bones, and a third will be performed below the L5 vertebra, (between L5 and S1).
Figure 5: To minimize bleeding in the cancellous bone of the pelvis during these pelvic osteotomies, we perform an anterior intra-abdominal approach and ligate the internal iliac vessels, arteries and veins before positioning the three Gigli saws. Two will be placed through the ischial notch and the iliac crest, and the third below the level of the L5 vertebra.
Figure 6: To make it easier to position the Gigli saws from inside the pelvic cavity to the patient's back, a cushion should be placed under the pelvis and sacrum. This cushion will be removed during surgery, allowing the doctor to easily remove the saws afterwards.
Figure 7: The patient is positioned supine in the gynecological position for the anterior retroperitoneal approach.
Figure 8: In this scenario, we isolate the vessels and nerves and use a puncture through the ischial notch to position the saws.

Video 2: which must be passed through the metal tube to exit the patient’s back.

Video 3: This diagram illustrates the position of the saws to be passed at the level of L5-S1, through the right and left iliac crests.

Figure 9: The saws are covered in plastic tubing, like an IV line,
Figure 10: An X-ray is then taken to check the correct positioning of the saws.
Figure 11: After placing the saws, we completed the previous approach and repositioned the patient in prone position.
Figure 12: We can see the Gigli saws that have been transferred to the patient's dorsal region.

Video 4: The posterior approach is then completed and all osteotomies are performed as illustrated in this diagram. An “en bloc resection” is then performed safely.

Video 5: We performed the osteotomies using the Gigli saws that were passed through the tubes.

Figure 13: Hemostasis is then reviewed.
Figure 14: Resection of the sacrum was completed as shown in the diagram.
Figure 15: En bloc resection, performed with an oncological margin.
Figure 16: The post-operative X-ray documents the total resection of the sacrum.
Figure 17: The patient remains bedridden, undergoing motor physiotherapy and will spend two months training to tolerate the orthostatic position.
Figure 18: After this period, he will start exercising on the parallel bars and will do gait training with Canadian crutches.

Video 6: In about three months she will be able to walk with the aid of crutches.

Case Author

Author: Prof. Dr. Pedro Péricles Ribeiro Baptista

 Orthopedic Oncosurgery at the Dr. Arnaldo Vieira de Carvalho Cancer Institute

Office :  Rua General Jardim, 846 – Cj 41 – Cep: 01223-010 Higienópolis São Paulo – SP

Phone: +55 11 3231-4638  Cell:+55  11 99863-5577   Email:  drpprb@gmail.com

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