The use of a pelvic displacement prosthesis to exclude the small intestinefrom the radiation field following radical hysterectomy

Objective. The goal of this study was to develop a device which will elevat e the small intestine out of the pelvic cavity during radiation after radic al surgery. Methods. A prosthetic device of silicone plastic was designed which conform s to the pelvis. This device is filled with saline and renograffin for X-ra y visualization. The capacity of the device is between 750 and 1500 cc. A s mall bowel contrast radiograph is performed prior to radiation to document exclusion from the radiation field. The device remains in place throughout radiation therapy and is then removed through a small incision after draini ng the contents of the prosthesis. Results. Seven devices have been placed to date. The patients' age ranged f rom 35 to 65 years. All women had stage Ib1 carcinoma of the cervix and all underwent a type III radical hysterectomy with bilateral pelvic and common iliac lymphadenectomy. The indication for placement of the device was deep invasion of tumor in five patients, close margin in one patient, and posit ive pelvic lymph nodes in one patient. The amount of fluid instilled in the device ranged from 960 to 1200 cc. All patients had a return to normal bow el function within 3 days of surgery. All had radiologically documented exc lusion of the small intestine from the radiation field prior to beginning r adiation. In the postoperative period there was one major complication: a p ulmonary embolism documented by pulmonary angiogram on postoperative day 2. All seven patients completed planned radiotherapy. The devices have been r emoved, with no adhesions to the prosthesis. Conclusions. The results of this study determine that the feasibility, safe ty, and efficacy of a prosthetic device in displacing the small bowel from the radiation field following radical surgery are sufficient to warrant a l arge-scale study. The device should be applicable to any and all tumors tha t require high dose pelvic radiation. It is expected that displacement of t he small intestine from the radiation field will diminish overall complicat ions and may allow delivery of radiation doses that approach colon and blad der tolerance, (C) 2000 Academic Press.