完全切除是复发性妇科恶性肿瘤的根治性治疗选择。横向扩展内盆腔切除术（LEER）是治疗横向复发的有效手术挽救疗法。然而，当复发肿瘤占据坐骨棘和骶骨时，则不需要 LEER，并且放弃手术挽救治疗。理论上，通过额外的骨盆骨切除以及标准 LEER 可以完全切除此类肿瘤。然而，由于超越LEER手术的解剖学复杂性，需要解决两个主要问题：坐骨神经损伤和骨盆截肢期间的肿瘤破坏。为了克服这些技术挑战，我们采用了多向超越 LEER 方法，这是一种新颖的挽救手术方法，旨在证明其技术可行性。我们创建了一个横向复发肿瘤的模拟模型，该肿瘤占据了右侧坐骨棘和骶骨。经过蒂尔防腐处理的尸体。安全地采用了多向方法，包括腹腔镜、会阴和背部阶段。我们在腹腔镜下用不同颜色的胶带标记了 L4-L5-S1 复合体和 S2 神经，并将它们拉入背侧手术区域，安全地保留了坐骨神经。使用胶带作为标志来对齐多向方法的解剖线，并在不破坏肿瘤的情况下完成肿瘤的完全清除。通过尸体训练，首例腹腔镜辅助超越 LEER 手术在复发性卵巢癌患者中成功实施。使用经过 Thiel 防腐处理的尸体，我们证明了保留坐骨神经的超越 LEER 手术的技术可行性。在一名复发性卵巢癌患者中成功进行了手术。© 2024。亚洲妇科肿瘤学会、韩国妇科肿瘤学会和日本妇科肿瘤学会。

Complete resection is the curative treatment choice for recurrent gynecological malignancies. Laterally extended endopelvic resection (LEER) is an effective surgical salvage therapy for lateral recurrence. However, when a recurrent tumor occupies the ischial spine and sacrum, LEER is not indicated, and surgical salvage therapy is abandoned. Theoretically, complete resection of such a tumor is possible by additional pelvic bone resection along with the standard LEER. Nevertheless, owing to the anatomical complexities of the beyond-LEER procedure, 2 major issues should be solved: sciatic nerve injury and tumor disruption during pelvic bone amputation. To overcome these technical challenges, we applied a multidirectional beyond-LEER approach, a novel salvage surgical procedure, with an aim of demonstrating its technical feasibility.We created a simulation model of a laterally recurrent tumor that occupied the right ischial spine and sacrum in a Thiel-embalmed cadaver.Multidirectional approaches, including laparoscopic, perineal, and dorsal phases, were safely applied. We laparoscopically marked the L4-L5-S1 complex and S2 nerve with different colored tapes, and by pulling them out into a dorsal surgical field, the sciatic nerve was safely preserved. The dissection lines of the multidirectional approaches were aligned using tapes as landmarks, and complete tumor clearance without tumor disruption was accomplished. By following the cadaveric training, the first laparoscopic-assisted beyond-LEER procedure was successfully performed in a patient with recurrent ovarian cancer.Using a Thiel-embalmed cadaver, we demonstrated the technical feasibility of a sciatic nerve-preserved beyond-LEER procedure, which was successfully performed in a patient with recurrent ovarian cancer.© 2024. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology, and Japan Society of Gynecologic Oncology.