Hemicorporectomy
Encyclopedia
In medicine
(surgery
), hemicorporectomy (also named translumbar amputation and "halfectomy") is a radical surgery
in which the body below the waist
is amputated, transecting the lumbar spine. This removes the leg
s, the genitalia (internal and external), urinary system
, pelvic
bones, anus
, and rectum
. It is a severely mutilating procedure recommended only as a last resort for patients with severe and potentially fatal illnesses such as osteomyelitis
, tumor
s, severe trauma
s and intractable decubiti in, or around, the pelvis
. It has only been reported a few dozen times in medical literature.
The nomenclature is somewhat at odds with generally accepted anatomical terms, as hemi is generally used to refer to one of two sides (e.g., hemiplegia
, which affects the arm and leg on one side of the body). In that sense, paracorporectomy might more closely reflect the nature of the procedure.
was vastly accelerated during, and following, the Second World War. Rarely experienced traumas were made more common by new weaponry. This required decisive surgical action as well as the development of new techniques. As B. E. Ferrara stated in his summative article on hemicorporectomy,
It was into this environment that Frederick E. Kredel first proposed the operation in February 1951 while discussing a paper on pelvic exenteration. The first hemicorporectomy was attempted by Charles S. Kennedy in 1960, but the patient died eleven days later. J. Bradley Aust and Karel B. Absolon conducted the first successful hemicorporectomy in Minnesota
in 1961.
affecting the pelvic girdle ("open-book fracture"), uncontrollable abscess
or ulcers of the pelvic region (causing sepsis
) or other locally uncontainable conditions. It is used in cases wherein even pelvic exenteration
would not remove sufficient tissue.
(rectum) and ileal conduit (bladder
). The second stage is the amputation.
set-point develops.
Removal of large parts of the colon
can lead to loss of electrolyte
s. Similarly, calculated measurements of renal function
(such as the Cockroft-Gault formula) are unlikely to reflect actual activity of the kidney
, as these calculations were developed for patients in whom the circulatory system correlates with the body weight; this relation is lost in a post-hemicorporectomy patient.
are necessary for a patient to return to some form of normal life, which invariably involves using a wheelchair
. Designing a prosthesis
for the removed body parts is difficult, as there is generally no remaining pelvic girdle musculature (unless this has been spared expressly).
hemicorporectomy. This stance is largely due to very limited rates of survival. A study which reviewed 267 cases of severe blunt and penetrating trauma patients (decapitation
, hemicorporectomy, etc.) who had cardiopulmonary arrest found that only 7 survived long term, only four of whom returned to their previous neurologic level. Apart from the overwhelming statistical unlikelihood of survival, operative hemicorporectomy is unlikely to be successful unless the patient has the "sufficient emotional and psychological maturity to cope" and "sufficient determination and physical strength to undergo the intensive rehabilitation".
Emergency rooms and ambulance services often release policy which advise against the resuscitation of such patients. The UK's National Health Service
, for example, in its "Policy and Procedures for the Recognition of Life Extinct" describes traumatic hemicorporectomy as "unequivocally associated with death" and that such injuries should be considered "incompatible with life". The National Association of EMS Physicians (NAEMSP) and the American College of Surgeons Committee on Trauma (COT) have also released similar position statements and policy allowing on-scene personnel to determine such patients unresuscitatable.
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
(surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
), hemicorporectomy (also named translumbar amputation and "halfectomy") is a radical surgery
Radical surgery
Radical surgery, also called radical dissection, refers to the removal of blood supply, lymph nodes and sometimes adjacent structures of a diseased organ or tumor during surgery. In surgical oncology, radical surgery typically describes the removal of a tumor or mass and ancillary lymph nodes that...
in which the body below the waist
Waist
The waist is the part of the abdomen between the rib cage and hips. On proportionate people, the waist is the narrowest part of the torso....
is amputated, transecting the lumbar spine. This removes the leg
Leg
Łęg may refer to the following places in Poland:*A former name for the town of Ełk *Part of the Czyżyny district of Kraków*Łęg, Pleszew County in Greater Poland Voivodeship...
s, the genitalia (internal and external), urinary system
Urinary system
The urinary system is the organ system that produces, stores, and eliminates urine. In humans it includes two kidneys, two ureters, the bladder and the urethra.-Kidney:...
, pelvic
Pelvis
In human anatomy, the pelvis is the lower part of the trunk, between the abdomen and the lower limbs .The pelvis includes several structures:...
bones, anus
Anus
The anus is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, unwanted semi-solid matter produced during digestion, which, depending on the type of animal, may be one or more of: matter which the animal cannot digest,...
, and rectum
Rectum
The rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...
. It is a severely mutilating procedure recommended only as a last resort for patients with severe and potentially fatal illnesses such as osteomyelitis
Osteomyelitis
Osteomyelitis simply means an infection of the bone or bone marrow...
, tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
s, severe trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
s and intractable decubiti in, or around, the pelvis
Pelvis
In human anatomy, the pelvis is the lower part of the trunk, between the abdomen and the lower limbs .The pelvis includes several structures:...
. It has only been reported a few dozen times in medical literature.
The nomenclature is somewhat at odds with generally accepted anatomical terms, as hemi is generally used to refer to one of two sides (e.g., hemiplegia
Hemiplegia
Hemiplegia /he.mə.pliː.dʒiə/ is total paralysis of the arm, leg, and trunk on the same side of the body. Hemiplegia is more severe than hemiparesis, wherein one half of the body has less marked weakness....
, which affects the arm and leg on one side of the body). In that sense, paracorporectomy might more closely reflect the nature of the procedure.
History
The development of surgical medicineSurgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
was vastly accelerated during, and following, the Second World War. Rarely experienced traumas were made more common by new weaponry. This required decisive surgical action as well as the development of new techniques. As B. E. Ferrara stated in his summative article on hemicorporectomy,
Lessons learned from battle field injuries quickened innovative treatment of congenital and acquired conditions... [the general surgeon] devised extensive cancer operations including extended radical mastectomyMastectomyMastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to treat breast cancer; in some cases, women and some men believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer...
, radical gastrectomyGastrectomyA gastrectomy is a partial or full surgical removal of the stomach.-Indications:Gastrectomies are performed to treat cancer and perforations of the stomach wall....
and pancreatectomyPancreatectomyIn medicine, a pancreatectomy is the surgical removal of all or part of the pancreas. Several types of pancreatectomy exist, including pancreaticoduodenectomy , distal pancreatectomy, segmental pancreatectomy, and total pancreatectomy...
, pelvic exenterationPelvic exenterationPelvic exenteration is a radical surgical treatment that removes all organs from a person's pelvic cavity. The urinary bladder, urethra, rectum, and anus are removed....
, the 'Commando OperationCommando OperationThe COMMANDO Operation or COMMANDO Procedure is a complicated operation for 1st degree malignancy of the tongue. It comprises glossectomy and hemimandibulectomy together with block dissection of the cervical nodes...
' (tongue, jaw and neck dissection), bilateral back dissection, hemipelvectomyHemipelvectomyA hemipelvectomy is a high level pelvic amputation. Along with hip disarticulations, hemipelvectomies are the rarest of lower extremity amputations. In some cases, an internal hemipelvectomy can be performed, which is a limb-sparing procedure. A complete hemipelvectomy, however, is the...
, and then hemicorporectomy or translumbar amputation, referred to as the most revolutionary of all operative procedures.
It was into this environment that Frederick E. Kredel first proposed the operation in February 1951 while discussing a paper on pelvic exenteration. The first hemicorporectomy was attempted by Charles S. Kennedy in 1960, but the patient died eleven days later. J. Bradley Aust and Karel B. Absolon conducted the first successful hemicorporectomy in Minnesota
Minnesota
Minnesota is a U.S. state located in the Midwestern United States. The twelfth largest state of the U.S., it is the twenty-first most populous, with 5.3 million residents. Minnesota was carved out of the eastern half of the Minnesota Territory and admitted to the Union as the thirty-second state...
in 1961.
Indications
The operation is most often performed to treat spreading cancers of the spinal cord and pelvic bones. Other reasons may include traumaPhysical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
affecting the pelvic girdle ("open-book fracture"), uncontrollable abscess
Abscess
An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...
or ulcers of the pelvic region (causing sepsis
Sepsis
Sepsis is a potentially deadly medical condition that is characterized by a whole-body inflammatory state and the presence of a known or suspected infection. The body may develop this inflammatory response by the immune system to microbes in the blood, urine, lungs, skin, or other tissues...
) or other locally uncontainable conditions. It is used in cases wherein even pelvic exenteration
Pelvic exenteration
Pelvic exenteration is a radical surgical treatment that removes all organs from a person's pelvic cavity. The urinary bladder, urethra, rectum, and anus are removed....
would not remove sufficient tissue.
Procedure
The surgical procedure is often done in two stages, but it is possible to conduct the surgery in one stage. The first stage is the discontinuation of the waste functions in colostomyColostomy
A colostomy is a surgical procedure in which a stoma is formed by drawing the healthy end of the large intestine or colon through an incision in the anterior abdominal wall and suturing it into place. This opening, in conjunction with the attached stoma appliance, provides an alternative channel...
(rectum) and ileal conduit (bladder
Urinary bladder
The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...
). The second stage is the amputation.
Considerations
With the removal of almost half of the circulatory system, cardiac function needs to be closely monitored while a new blood pressureBlood pressure
Blood pressure is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs. When used without further specification, "blood pressure" usually refers to the arterial pressure of the systemic circulation. During each heartbeat, BP varies...
set-point develops.
Removal of large parts of the colon
Colon (anatomy)
The colon is the last part of the digestive system in most vertebrates; it extracts water and salt from solid wastes before they are eliminated from the body, and is the site in which flora-aided fermentation of unabsorbed material occurs. Unlike the small intestine, the colon does not play a...
can lead to loss of electrolyte
Electrolyte
In chemistry, an electrolyte is any substance containing free ions that make the substance electrically conductive. The most typical electrolyte is an ionic solution, but molten electrolytes and solid electrolytes are also possible....
s. Similarly, calculated measurements of renal function
Renal function
Renal function, in nephrology, is an indication of the state of the kidney and its role in renal physiology. Glomerular filtration rate describes the flow rate of filtered fluid through the kidney...
(such as the Cockroft-Gault formula) are unlikely to reflect actual activity of the kidney
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
, as these calculations were developed for patients in whom the circulatory system correlates with the body weight; this relation is lost in a post-hemicorporectomy patient.
Rehabilitation
Extensive physiotherapy and occupational therapyOccupational therapy
Occupational therapy is a discipline that aims to promote health by enabling people to perform meaningful and purposeful activities. Occupational therapists work with individuals who suffer from a mentally, physically, developmentally, and/or emotionally disabling condition by utilizing treatments...
are necessary for a patient to return to some form of normal life, which invariably involves using a wheelchair
Wheelchair
A wheelchair is a chair with wheels, designed to be a replacement for walking. The device comes in variations where it is propelled by motors or by the seated occupant turning the rear wheels by hand. Often there are handles behind the seat for someone else to do the pushing...
. Designing a prosthesis
Prosthesis
In medicine, a prosthesis, prosthetic, or prosthetic limb is an artificial device extension that replaces a missing body part. It is part of the field of biomechatronics, the science of using mechanical devices with human muscle, skeleton, and nervous systems to assist or enhance motor control...
for the removed body parts is difficult, as there is generally no remaining pelvic girdle musculature (unless this has been spared expressly).
Traumatic hemicorporectomy
Many emergency rooms have protocols under which they will not resuscitate or support a patient who has already undergone a severe bisection injury that is essentially a de factoDe facto
De facto is a Latin expression that means "concerning fact." In law, it often means "in practice but not necessarily ordained by law" or "in practice or actuality, but not officially established." It is commonly used in contrast to de jure when referring to matters of law, governance, or...
hemicorporectomy. This stance is largely due to very limited rates of survival. A study which reviewed 267 cases of severe blunt and penetrating trauma patients (decapitation
Decapitation
Decapitation is the separation of the head from the body. Beheading typically refers to the act of intentional decapitation, e.g., as a means of murder or execution; it may be accomplished, for example, with an axe, sword, knife, wire, or by other more sophisticated means such as a guillotine...
, hemicorporectomy, etc.) who had cardiopulmonary arrest found that only 7 survived long term, only four of whom returned to their previous neurologic level. Apart from the overwhelming statistical unlikelihood of survival, operative hemicorporectomy is unlikely to be successful unless the patient has the "sufficient emotional and psychological maturity to cope" and "sufficient determination and physical strength to undergo the intensive rehabilitation".
Emergency rooms and ambulance services often release policy which advise against the resuscitation of such patients. The UK's National Health Service
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
, for example, in its "Policy and Procedures for the Recognition of Life Extinct" describes traumatic hemicorporectomy as "unequivocally associated with death" and that such injuries should be considered "incompatible with life". The National Association of EMS Physicians (NAEMSP) and the American College of Surgeons Committee on Trauma (COT) have also released similar position statements and policy allowing on-scene personnel to determine such patients unresuscitatable.
Prosthetic
Following a hemicorporectomy, patients are fitted with a socket-type prosthetic often referred to as a bucket. Early bucket designs often presented significant pressure problems for patients, but new devices have incorporated an inflatable rubber lining composed of air pockets that evenly distributes pressure based on the patient's motions. Two openings at the front of the bucket create space for the colostomy bag and the ileal conduit.See also
- AmputationAmputationAmputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for...
- Sawing a woman in halfSawing a woman in halfSawing a woman in half is a generic name for a number of different stage magic tricks in which a person is apparently sawn or divided into two or more pieces.-History:...
- Magic trick - The GodwhaleThe GodwhaleThe Godwhale is a science fiction novel by American novelist T. J. Bass, first published in 1974. It is the sequel to Half Past Human. The book was nominated for the Nebula Award for Best Novel in 1974...
, a science fiction novel featuring a protagonist who has undergone this procedure
External links
- A new concept in prosthetic interface design
- Mr Amri Mohd Samat - a 41 year old who has had the surgery after a devastating infection. Photo included.
- hemicorporectomy.org - The blog of a New York woman who has this operation in 2010.