Introduction/Background*To demonstrate the true anatomical boundaries and surgical technique for radical vulvectomy on a live patient.
Methodology This surgical video was recorded at Ankara City Hospital, where is an ESGO Accredited Gynecologic Oncology Center.
Result(s)*• A proper vulvar incision depending on the localization of the tumor with 2cm lateral gross margin if possible is performed (close to the urethra and anus this margin will decrease to 1cm).
• The incision deepens down to the level of perineal membrane (the inferior fascia of the urogenital diaphragm which is superior to the superficial perineal space) by passing through the subcutaneous fatty tissue with creating dissection tunnels.
• At the cranial part of the dissection, the pubic periosteum is found and here, the suspensory ligament of clitoris with the dorsal artery of clitoris should be ligated.
• At the craniolateral part of the vulvar dissection, the adductor fascia is encountered.
• At the caudolateral part of the vulvar dissection, the perineal branches of the internal pudendal artery lie at the 5 and 7 o’clock positions of the vulva.
• At the caudal part of the vulvar dissection, the posterior vulvar tissue is dissected from the perineal body and here, the dissection proceeds over the rectovaginal septum.
• A circumferential vaginal inner incision encircling the vaginal introitus and lying superior to the external urethral meatus is performed, by the way the outer vulvar and inner vaginal incision are bounded. Here, a Foley catheter may secure the urethra.
• After excision of the vulvar tissue; if possible, the wound is closed primarily. First, the deep subcutaneous part is closed and the lateral margin of the vaginal introitus is sutured to the medial edge of the vulvar excision line.
• If it is not possible to close the wound with primary sutures, a flap reconstruction is performed.
Conclusion*The perineal arteries at 5 and 7 o’clock positions should be kept on mind while performing a radical vulvectomy and the deepness of the excision at the base of the tumor should extend to the level of the perineal membrane.
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