Hemicorporectomy is a radical surgery in which the body below the

waist The waist is the part of the abdomen between the rib cage and hips. On people with slim bodies, the waist is the narrowest part of the torso. ''Waistline'' refers to the horizontal line where the waist is narrowest, or to the general appear ...

is amputated, transecting the

lumbar spine The lumbar vertebrae are, in human anatomy, the five vertebrae between the rib cage and the pelvis. They are the largest segments of the vertebral column and are characterized by the absence of the foramen transversarium within the transverse p ...

. This removes the

leg A leg is a weight-bearing and locomotive anatomical structure, usually having a columnar shape. During locomotion, legs function as "extensible struts". The combination of movements at all joints can be modeled as a single, linear element ca ...

s, the

genitalia A sex organ (or reproductive organ) is any part of an animal or plant that is involved in sexual reproduction. The reproductive organs together constitute the reproductive system. In animals, the testis in the male, and the ovary in the female, a ...

(internal and external),

urinary system The urinary system, also known as the urinary tract or renal system, consists of the kidneys, ureters, bladder, and the urethra. The purpose of the urinary system is to eliminate waste from the body, regulate blood volume and blood pressure, c ...

pelvic The pelvis (plural pelves or pelvises) is the lower part of the trunk, between the abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also called bony pelvis, or pelvic skeleton). The p ...

bones, anus, and rectum. It is an extremely mutilating procedure recommended only as a last resort for people with severe and potentially fatal illnesses such as

osteomyelitis Osteomyelitis (OM) is an infection of bone. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. The long bones of the arms and legs are most commonly involved in children e.g. the femur and humerus, while the ...

tumor A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

s, severe

trauma Trauma most often refers to: * Major trauma, in physical medicine, severe physical injury caused by an external source * Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic i ...

s and intractable

decubiti Pressure ulcers, also known as pressure sores, bed sores or pressure injuries, are localised damage to the skin and/or underlying tissue that usually occur over a bony prominence as a result of usually long-term pressure, or pressure in combi ...

in, or around, the pelvis. By 2009, 66 cases have been reported in medical literature. The most recent documented operation was in September 2019.

Medical uses

The operation is performed to treat spreading cancers of the spinal cord and pelvic bones. Other reasons may include

affecting the pelvic girdle (" open-book fracture"), uncontrollable abscess or

ulcer An ulcer is a discontinuity or break in a bodily membrane that impedes normal function of the affected organ. According to Robbins's pathology, "ulcer is the breach of the continuity of skin, epithelium or mucous membrane caused by sloughing o ...

s of the pelvic region (causing

sepsis Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...

) or other locally uncontainable conditions. It is used in cases wherein even

pelvic exenteration Pelvic exenteration (or pelvic evisceration) is a radical surgical treatment that removes all organs from a person's pelvic cavity. It is used to treat certain advanced or recurrent cancers. The urinary bladder, urethra, rectum, and anus are r ...

would not remove sufficient tissue.

Procedure

The surgical procedure is typically 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 by performing a

colostomy A colostomy is an opening (stoma) in the large intestine (colon), or the surgical procedure that creates one. The opening is formed by drawing the healthy end of the colon through an incision in the anterior abdominal wall and suturing it into ...

and

ileal conduit An ileal conduit urinary diversion is one of various surgical techniques for urinary diversion. It has sometimes been referred to as the Bricker ileal conduit after its inventor, Eugene M. Bricker. It is a form of incontinent urostomy, and was de ...

in the upper abdominal quadrants. The second stage is the amputation at the

Considerations

With the removal of almost half of the circulatory system,

cardiac The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide to t ...

function needs to be closely monitored while a new blood pressure set-point develops. Removal of large parts of the colon can lead to loss of electrolytes. Similarly, calculated measurements of renal function (such as the Cockcroft-Gault formula) are unlikely to reflect actual activity of the

kidney The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; blo ...

, 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 therapy are necessary for a patient to return to some form of normal life, which generally involves using a

wheelchair A wheelchair is a chair with wheels, used when walking is difficult or impossible due to illness, injury, problems related to old age, or disability. These can include spinal cord injuries ( paraplegia, hemiplegia, and quadriplegia), cerebr ...

. 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). As for now, it's unknown if a

lower body The pelvis (plural pelves or pelvises) is the lower part of the trunk, between the abdomen and the thighs (sometimes also called pelvic region), together with its embedded skeleton (sometimes also called bony pelvis, or pelvic skeleton). The p ...

transplant is possible to give hemicorporectomy survivors a new chance.

Traumatic hemicorporectomy

Individuals sustaining a severe bisection injury that is essentially a ''

de facto ''De facto'' ( ; , "in fact") describes practices that exist in reality, whether or not they are officially recognized by laws or other formal norms. It is commonly used to refer to what happens in practice, in contrast with ''de jure'' ("by la ...

'' hemicorporectomy would rarely reach a hospital before dying. A study that reviewed 267 cases of patients who sustained severe blunt and penetrating trauma, and who were in cardiopulmonary arrest, found that only 7 survived long-term, only four of whom returned to their previous neurologic level. Apart from the very low likelihood of surviving such an injury, even an operative hemicorporectomy is unlikely to be successful unless the patient has "sufficient emotional and psychological maturity to cope" and "sufficient determination and physical strength to undergo the intensive rehabilitation". Emergency rooms and ambulance service policies advise against the resuscitation of such patients. The UK's

National Health Service The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...

, for example, in its "Policy and Procedures for the Recognition of Life Extinct" describes traumatic hemicorporectomy (along with decapitation) as "unequivocally associated with death" and that such injuries should be considered "incompatible with life" in patients under 18. 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 if patients are to be considered unresuscitatable. In one case documented by the '' Archives of Emergency Medicine'' in 1989, a woman who sustained a complete corporal transection (hemicorporectomy) after being struck by a train arrived at a hospital in a "fully conscious" state and "was aware of the nature of her injury and wished for further treatment." Although the patient was initially stabilized and underwent three hours of emergency surgery, she died approximately two hours later due to "

hypovolaemia Hypovolemia, also known as volume depletion or volume contraction, is a state of abnormally low extracellular fluid in the body. This may be due to either a loss of both salt and water or a decrease in blood volume. Hypovolemia refers to the los ...

cardiac arrhythmia Arrhythmias, also known as cardiac arrhythmias, heart arrhythmias, or dysrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. A resting heart rate that is too fast – above 100 beats per minute in adults ...

and biochemical imbalance."

Prosthesis

Following a hemicorporectomy, patients are fitted with a socket-type prosthesis 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

History

The development of surgical medicine was vastly accelerated during, and following, the

Second World War World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposi ...

. 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 ... he general surgeondevised extensive cancer operations including extended radical
mastectomy Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. A mastectomy is usually carried out to treat breast cancer. In some cases, women believed to be at high risk of breast cancer have the operat ...
, radical
gastrectomy A gastrectomy is a partial or total surgical removal of the stomach. Indications Gastrectomies are performed to treat stomach cancer and perforations of the stomach wall. In severe duodenal ulcers it may be necessary to remove the lower port ...
and pancreatectomy,
pelvic exenteration Pelvic exenteration (or pelvic evisceration) is a radical surgical treatment that removes all organs from a person's pelvic cavity. It is used to treat certain advanced or recurrent cancers. The urinary bladder, urethra, rectum, and anus are r ...
, the ' Commando Operation' (tongue, jaw and neck dissection), bilateral back dissection,
hemipelvectomy Hemipelvectomy, also known as a pelvic resection, is a surgical procedure that involves the removal of portion of the pelvic girdle. This procedure is most commonly performed to treat oncologic conditions of the pelvis. Hemipelvectomy can be furthe ...
, 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.

List of people with Hemicorporectomy

* Loren Schauers is an American man with the most recent case of the procedure. He has had the hemicorporectomy amputation in 2019 after a traumatic forklift accident. Loren and his wife Sabia have a YouTube channel where they document Loren’s new lifestyle without half of his body.

References

External links

* {{cite journal, title=A New Concept in Prosthetic Interface Design for Hemicorporectomy Amputees Using ROHO Compression Therapy: A Case Study From a CPO's Perspective, author=Wilson, Jon D., journal=Journal of Prosthetics & Orthotics, date=October 2004, volume=16, issue=4, doi=10.1097/00008526-200410000-00003, s2cid=72553863, pages=104–112, doi-access=free Surgical oncology Surgical removal procedures Types of amputations