Internal Hemipelvectomy - Indication, Techniques, and Complications

Introduction

Internal hemipelvectomy is a complex surgical procedure involving the partial removal of the pelvis. It is primarily performed to treat advanced tumors or severe trauma that affects the pelvic region. This article provides an in-depth overview of internal hemipelvectomy, including its surgical techniques, indications, and the subsequent rehabilitation process. Understanding this procedure is crucial for healthcare professionals and patients alike to comprehend the challenges and potential outcomes associated with internal hemipelvectomy.

What Is Internal Hemipelvectomy?

Internal hemipelvectomy is an intricate surgical procedure that includes the removal of a portion of the pelvic bone, usually on one side. This procedure may be performed through different approaches, including anterior, posterior, or combined approaches, depending on the location and extent of the tumor or trauma. The aim of internal hemipelvectomy is to completely excise the affected region while preserving nearby vital structures, such as blood vessels, nerves, and adjacent organs.

What Are the Indications of Internal Hemipelvectomy?

Internal hemipelvectomy is a surgical procedure performed to treat advanced pelvic tumors or severe pelvic trauma. It is indicated when the tumor has spread extensively within the pelvis or when conservative treatment options have been ineffective. This procedure is recommended for cases where the tumor cannot be completely removed through other methods.

The primary indication for internal hemipelvectomy is to achieve complete tumor resection, reducing the risk of tumor recurrence and improving long-term disease control. It is also performed to alleviate severe pain caused by the tumor or trauma.

The decision to undergo internal hemipelvectomy is made after a thorough examination by a multidisciplinary team, including orthopedic surgeons, oncologists, and radiologists. They consider various factors such as the tumor type, location, extent of involvement, and the overall health of the patient.

Internal hemipelvectomy is a complex procedure, but it can offer significant benefits for patients with advanced pelvic tumors or trauma. It aims to improve the patient's quality of life by reducing pain, controlling the disease, and restoring functionality to the pelvic region.

What Are the Internal Hemipelvectomy Techniques?

Internal hemipelvectomy is a complex surgical procedure that involves the partial removal of the pelvis. The specific technique used may vary depending on the location and extent of the tumor or trauma. Here are the main surgical techniques employed in internal hemipelvectomy:

• Anterior Approach: This technique involves accessing the pelvis through an incision in the abdomen. It provides direct access to the front part of the pelvic bone. The surgeon carefully removes the affected portion of the pelvis, ensuring complete tumor resection while preserving structures present nearby, such as blood vessels, nerves, and adjacent organs.

• Posterior Approach: In the posterior approach, the surgeon accesses the pelvis through an incision in the back. This technique is commonly used for tumors or trauma affecting the sacrum or ilium. The affected part of the pelvic bone is meticulously removed while avoiding damage to surrounding nerves and blood vessels.

• Combined Approach: In complex cases where the tumor or trauma involves multiple regions of the pelvis, a combined approach may be utilized. This approach combines both the anterior and posterior incisions to achieve complete removal of the affected pelvic bone. It allows for a comprehensive resection of the tumor while preserving vital structures.

During the surgery, the surgeon may utilize specialized instruments to remove the bone, such as drills, saws, or osteotomes. Reconstruction techniques may also be employed to restore stability to the remaining pelvis, such as using bone grafts, metal implants, or prosthetic devices.

The choice of surgical technique completely depends on the specific characteristics of the tumor or trauma, as well as the surgeon's expertise and preference. The goal of each technique is to achieve complete tumor resection while preserving functionality and minimizing the risk of complications.

What Are the Advantages of Internal Hemipelvectomy?

The following are the advantages of internal hemipelvectomy -

• Tumor Control: Internal hemipelvectomy offers the potential for complete tumor resection, which is crucial for improving the chances of long-term disease control.

• Pain Relief: The procedure can provide significant pain relief for patients with advanced pelvic tumors or trauma that cause severe pain.

• Quality of Life: Internal hemipelvectomy can enhance the quality of life by pain relief, improving mobility, and restoring functionality.

What Are the Disadvantages of Internal Hemipelvectomy?

The following are the disadvantages of internal hemipelvectomy -

• Complexity: Internal hemipelvectomy is a complex surgical procedure that requires a high level of expertise and multidisciplinary collaboration.

• Functional Limitations: The removal of a portion of the pelvis can result in functional limitations, including changes in gait, reduced mobility, and potential bowel and bladder disturbances.

• Psychological Impact: The procedure and its associated functional limitations can have a significant psychological impact on patients, necessitating psychological support and counseling.

How to Prepare for Internal Hemipelvectomy?

Preparing for an internal hemipelvectomy is crucial to ensure the best possible outcome. The following are some points to consider before surgery.

• Consultation and Evaluation: Schedule an appointment with an orthopedic surgeon or healthcare team to discuss the procedure. They will evaluate the case, review the medical history, and perform necessary tests and imaging to assess the extent of the tumor or trauma.

• Medical Examination: Ensure that the patient gets medical clearance from the primary care physician or other specialists involved in the care. They will assess the overall health and manage any underlying medical conditions before surgery.

• Communication and Support: Discuss the procedure with the healthcare team and ask any questions or concerns a patient may have. They can provide detailed information about the surgery, expected outcomes, and potential risks. Additionally, consider seeking emotional support from family, friends, or support groups to help cope with the process.

• Preoperative Instructions: Follow any preoperative instructions provided by the surgeon. This may include fasting for a certain period before the surgery, stopping certain medications, or undergoing specific tests or preparations.

• Lifestyle Adjustments: Make necessary lifestyle adjustments to optimize health and well-being. This may include maintaining a healthy diet, regular exercise, quitting smoking, and managing stress.

• Prepare the Home: Before the surgery, ensure the home is prepared for the postoperative needs. Arrange for assistance with daily activities, ensure a clean and safe environment, and set up any necessary assistive devices or equipment a person may require during recovery.

• Support System: Coordinate with family members, friends, or caregivers who can provide assistance and support during the recovery period.

• Preparing for Hospital Stay: Pack a bag with essential items such as comfortable clothing, toiletries, and any personal items that can provide comfort during the hospital stay. Follow any specific instructions regarding medication, fasting, or arrival time provided by the hospital.

What Are the Complications Associated with Internal Hemipelvectomy?

Internal hemipelvectomy is associated with potential complications, including:

• Blood Loss: The procedure carries the risk of significant blood loss, requiring careful monitoring and transfusion if necessary.

• Infection: Surgical site infections can occur, necessitating antibiotic therapy and wound care.

• Nerve Damage: Damage to nearby nerves can lead to sensory or motor deficits.

• Impaired Bowel and Bladder Function: The surgical intervention may affect bowel and bladder function, requiring ongoing management and potential intervention.

Conclusion:

Internal hemipelvectomy is a complex surgical procedure used to treat advanced pelvic tumors or severe pelvic trauma. While it offers advantages such as tumor control, pain relief, and enhanced quality of life, it also carries disadvantages and potential complications. A comprehensive evaluation of the patient's condition, careful surgical planning, and a multidisciplinary approach are essential for achieving optimal outcomes and providing appropriate postoperative care. The decision to undergo internal hemipelvectomy should be made through a collaborative effort between the patient and their healthcare team, weighing the potential benefits against the associated risks and functional limitations.