Combined surgical approach for large sacral chordoma resection with pelvic floor reconstruction - a video vignette.

Chordoma is a rare spinal tumour with the most common location the pelvic surface of the sacrum. This tumour can be asymptomatic for a long time, reaching large sizes. Due to its extensive growth, it compresses the surrounding tissues and organs, displaces the pelvic organs, which makes surgical treatment of such tumours difficult in terms of changing the anatomy of the pelvis. Preoperative MR imaging is vital to make the correct diagnosis, through identification of features that may help alert the surgeon of potential difficulty such as pelvic side-wall or greater sciatic nerve involvement [1]. Surgery is the first choice of treatment in the case of a large sacrococcygeal chordoma [2]. Operative treatment can be undertaken with low morbidity, either by open or laparoscopic surgery [3], or laparoscopic surgery combined with a posterior approach. Laparoscopic approach for large sacral chordoma treatment is a feasible and safe option that reduces surgical trauma and offers an excellent tool for perfect visualization of the deep structures in the presacral space to minimize vascular and neurological injuries [4, 5, 6]. For large tumours in the pelvis, a combined anterior and posterior approach may be advisable.