Introduction/Background Staging for vulvar cancer requires primary tumor resection. When the disease involves the anus, rectum, rectovaginal septum, posterior pelvic exenteration with permanent colostomy may be required. Laparoscopic posterior exenteration is a complex and rarely done procedure. We suggest the surgical procedure for laparoscopic posterior pelvic exenteration with vulvar reconstruction for locally advanced vulvar cancer.

Methodology This is a step-by-step video presentation of laparoscopic posterior pelvic exenteration with primary direct appositional vaginal repair. The patient was a 63-year-old woman (body mass index 25.1kg/m²) with locally advanced clear cell adenocarcinoma. The preoperative magnetic resonance imaging/positron emission tomography showed suspicious lesion to anal intersphincteric space. The surgery was performed including laparoscopic total hysterectomy with both salpingo-oophorectomy, laparoscopic abdominoperineal resection of rectum, colostomy, and total vaginectomy. Vulvar reconstruction with bilateral V-Y advancement flap coverage was performed.

Results The operation was performed successfully with no intra-operative or postoperative complications. Total duration of surgery was 450 minutes. The estimated blood loss was 200mL. The patient was discharged on day 10. The pathology report was clear cell carcinoma. The tumor size was 2.7*2.5*1.3cm without other organ involvement, The International Federation of Gynecology and Obstetrics stage IB. No residual lesion was found at the surgical margin. Radiation treatment was performed as adjuvant therapy following initial surgery. The patient is alive without recurrence 13months after the initial treatment.

Conclusion This is a case of locally advanced vulvar cancer for which complete response was achieved by laparoscopic posterior resection and vulvar reconstruction, without severe adverse effects and with no observed recurrence 13months after the surgery.

Disclosures We have no conflicts of interest to disclose.