Carbon ion radiotherapy is more effective than ordinary radiotherapy for locally advanced cancer control. However, its use against tumors adjacent to the gastrointestinal tract or urinary tract is restricted, because the intestines have low tolerance to radiation. This article describes a new technical procedure of laparoscopic spacer insertion (LSI) that prevents radiation-induced intestinal damage during treatment of sacral chordomas. On the basis of computed tomography and magnetic resonance imaging, a patient with sacral pain was diagnosed with an unresectable chordoma (5×3.5 cm in size) located at S3 and S4. We selected carbon ion radiotherapy, but because the tumor was adjacent to the rectum, we first performed LSI. We mobilized the colon and the rectum from the distal sigmoid colon to the lower rectum at the levator ani muscle via two 12-mm and three 5-mm ports. Then we covered the tumor completely with a spacer, a GORE-TEX® Soft tissue patch (2 mm thick, 20×12 cm in size), and sutured it in place with 4-0 Vicryl®. The postoperative course was uneventful, and the patient was discharged on the 6th postoperative day. Simple, relatively noninvasive, and effective in reducing intestinal damage, this LSI procedure opens up new possibilities for the application of carbon ion radiotherapy.
