PMC6942784_01
Magnetic resonance images show a large tumor directly invading the urinary bladder (arrowhead) and an abscess between the tumor and urinary bladder (arrow).
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Besides, an abscess was formed between the tumor and the urinary bladder (Figures 1 and 2).
Schema of the tumor and peripheral organs.
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Besides, an abscess was formed between the tumor and the urinary bladder (Figures 1 and 2).
Laparoscopic views before and after the extended surgery with en bloc resection of the urinary bladder, left ureter, and left lateral lymph nodes. EIV: external iliac vein; EIA: external iliac artery; IOM: internal obturator muscle; LAM: levator ani muscle; IIA: internal iliac artery.
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Subsequently, we mobilized the rectum to the bottom of the pelvic floor on the right and posterior sides while completely preserving the right nerve plexus; this point was used as the surgical landmark on the posterior side (Figure 3). At the distal side of the lateral pelvic area, we achieved the landmark on the posterior side in front of the levator ani muscle with en bloc resection of the hypogastric nerve and pelvic nerve plexus; this point was used as the surgical landmark on the lateral side (Figure 3). We resected the distal wall of the urinary bladder by connecting the line from the right side of the rectum to the surgical landmark on the lateral side (Figure 3).
Laparoscopic view after the reconstruction, the photo of the resected specimen, and the photo of the abdomen 1 month after the surgery. EIV: external iliac vein; EIA: external iliac artery; IOM: internal obturator muscle.
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The reconstruction of the left ureter and the urinary bladder was performed under direct vision, and the reconstruction of the rectum was also performed laparoscopically (Figure 4). The pathological results revealed that the tumor involved the muscle layer of the urinary bladder and the outer membrane of the left ureter; however, the results were negative for cancer at the margin (Figure 4).