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 technique using Gigli saws Part II

Total sacrectomy technique using Gigli saws Part II

Total sacrectomy technique using Gigli saws Part II

Check out the video of the lecture

Total sacrectomy technique using Gigli saws Part II

In this second part of the total sacrectomy technique using Gigli saws, we will demonstrate its evolution, highlighting the use of laparoscopy. We will discuss its application for guiding the Gigli saws from the pelvic cavity to the dorsal region of the patient.

The first time we used laparoscopy was in a case involving a patient with an osteolytic lesion in the S-3 sacral foramen.

She presented with clinical symptoms of pain and numbness in her left leg. The X-ray revealed an enlarged foramen in the S-3 sacral vertebra. The CT scan showed a well-defined area, and the MRI exhibited a circumscribed lesion, bounded by a thick pseudocapsule. In the sagittal section, we observed the formation of a sacral tumor and its continuity with the nerve root, suggesting it was a schwannoma. An arteriography was performed for further study. The CT reconstruction indicated that the lesion was likely slow-growing, chronic, and benign.

A surgeon performed the laparoscopy, opening the retroperitoneum and isolating the iliac vessels under our guidance, to ligate and cut the left internal iliac artery and vein. Then, the tumor was exposed, and we confirmed its continuity with the S-3 root, resembling a horse’s tail. Next, he placed the tumor inside a surgical glove and aspirated the contents, removing everything through the laparoscopic tube. The patient was able to walk on the second day after surgery.

We discussed the possibility of performing the dissection of sacral tumors by passing the Gigli saws laparoscopically. To acquire the learning curve, we started with a case of Ewing’s sarcoma affecting the sacrum below S-3. In this case, we only needed to pass one saw horizontally. The tumor was successfully resected oncologically.

A Kirschner wire is placed as a guide, and we position two segments of the tube: the first is shorter and will exit through the patient’s back, while the second will push the first and be removed first, as per the diagram. We repeated this operation for the passage of the other saws. This way, we have the three saws safely positioned to make the osteotomies through the posterior approach. Currently, we use laparoscopy to perform all the procedures that were previously done through the anterior approach.

The case of a patient with a large volume chordoma, involving the entire sacrum and with difficulty in defecating and urinating, who had been bedridden for eight months in another hospital, was decisive in the approval of this technique. The patient had pressure ulcers and a posture of hip and knee flexion. She was operated on using the Gigli saw technique, positioned laparoscopically, and then we performed the release and lengthening of the hip and knee flexors, realigning the lower limbs. This chordoma case, despite its severity, was successfully operated on, and the total sacrectomy with laparoscopic assistance was successful. The patient started physiotherapy and rehabilitation of bladder and bowel excretory functions through abdominal maneuvers. She can walk with the aid of a walker and is reintegrated into daily life, independently, despite motor deficits in the ankle dorsiflexor muscles.

Sacrectomy with laparoscopic assistance is advantageous, presenting shorter surgery times, reduced need for blood transfusions, and satisfactory functional outcomes. Currently, we see no need to perform reconstructions.

Total sacrectomy

Total sacrectomy technique using Gigli saws Part I

Total sacrectomy

Check out the video of the lecture

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.


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! 

Artrodese do doelho com Solução Protética ou Biológica

Knee Arthrodesis

Artrodese do doelho com Solução Protética ou Biológica

Knee Arthrodesis with Prosthetic or Biological Solution

In some cases of bone tumors and severe trauma, failure of prostheses or osteosynthesis can represent a significant challenge. It is in this scenario that knee arthrodesis emerges as a viable alternative. This technique can be performed in several ways, one of which is with a diaphyseal-type prosthesis or through a biological solution using autologous graft and osteosynthesis.

For example, when we are faced with the failure of an infected primary prosthesis or in situations of aggressive bone tumors or trauma, arthrodesis can become an alternative to amputation.

Let us consider this case of recurrent chondrosarcoma, after two unsuccessful surgical attempts, in which the need for a wide resection is present, and reconstruction with arthrodesis may be the only alternative to avoid amputation. In these cases, arthrodesis using a diaphyseal prosthesis may offer the chance of preserving this limb.

Success requires careful resection, with the removal of compromised tissues, preserving the popliteal vessels and nerves in the region. Then, reconstruction is carried out with a modular prosthesis of the diaphyseal type, in this case it was specially molded, with the manufacture of a polyethylene segment, aiming to give a more aesthetic shape to the “neo knee” region, minimizing the defect left by the extensive resection of the segment affected by the tumor and meeting the objective of ensuring a wide resection, with safe oncological margins.

In this other example of a giant cell tumor, which destroyed the entire tibial plateau and the proximal 1/3 of the tibia, the approach may be biological. In this patient, we used autologous bone from the site itself, in the case of the femoral condyles, to fill the bone gap left by the resection of the neoplasm.

It is important to highlight that the technique requires precision and care, both in resection and reconstruction. The plate used for fixing must be positioned to ensure adequate alignment and avoid unwanted rotations. The integration of arthrodesis with the biological autograft is essential for the success of the procedure.

In cases of severe trauma, with extensive bone destruction due to high-energy trauma, arthrodesis may be the only viable option to restore limb stability and avoid amputation. These cases, which we are showing, were presented at the International Knee Trauma Congress, in Ribeirão Preto – SP, showing our experience with these two arthrodesis techniques, using diaphyseal prostheses or osteosynthesis with biological reconstruction. For more information about these techniques and appreciation of other similar clinical cases, visit the website ,

 By sharing knowledge and experience, we will be able to advance developments in the treatment of complex orthopedic conditions.

Check out the video of the surgery below.

Tumor Ósseo Primitivo: Sarcoma de Ewing

Ewing’s sarcoma Transposition of the radius to the ulna

Tumor Ósseo Primitivo: Sarcoma de Ewing

Ewing's sarcoma
Transposition of the radius to the ulna

Ewing’s sarcoma. In 2007, we performed a surgical procedure to treat a primitive bone tumor, diagnosed as Ewing Sarcoma . This form of tumor is known for its aggressiveness and treatment challenges. The surgical intervention involved resection of the ulna, a bone in the forearm, which was affected by the injury.

Before surgery, tests such as bone scintigraphy and resonance were performed to stage the extent of the tumor. The results indicated a single injury to the right ulna. We opted for a surgical approach after the neoadjuvant chemotherapy phase.

The surgery began with meticulous preparation of the patient and the delimitation of the biopsy path to guide the resection, with an oncological margin. The iliac bone was prepared to obtain an autologous graft segment, necessary for wrist reconstruction, after removal of the compromised ulna segment. We use the term cautery (electric scalpel) to dissect tissues with better hemostasis and precision, minimizing damage to surrounding tissues and obtaining a better oncological margin.

After circumferential delimitation of the tumor, we performed resection of the compromised ulna, followed by preparation for the reconstruction by placing the head of the radius, the other bone of the forearm, in the groove between the humeral condyles, suitable to function with flexion-extension, in this new forearm with a single bone. The iliac bone graft segment was then used to promote distal radio-ulnar synostosis, that is, the fusion of the radius and ulna bones, stabilizing the new wrist.

During surgery, suture techniques were used to fix the head of the radius to the tendon of the triceps brachii muscle, to ensure the stability of the new elbow, providing satisfactory flexion-extension. Screw and pin were used to ensure adequate fixation of the distal radio-ulnar synostosis.

After completion of the surgery, an x-ray was performed to evaluate the outcome of the procedure. The tumor was completely resected, and bone reconstruction was successful. The patient was advised on postoperative care, including physical therapy to promote functional recovery of the affected limb.

The surgery was an important milestone in the patient’s journey against Ewing’s sarcoma, representing a significant step in the treatment of this complex disease and providing good function of the operated limb.

Through a multidisciplinary approach and appropriate technology, we are able to fulfill our commitment to providing the best possible care to patients facing such complex and difficult health challenges.

Prof. Dr. Pedro Péricles Ribeiro Baptista   +55 11 99863-5577

Check out the video of the surgery below.

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