Total pelvic exenteration (TPE) was started by Brunshwig in the 1940s for the surgical treatment of progressive and recurrent cervical cancer and endometrial cancer, and was performed by Appleby in 1950 for patients with progressive rectal cancer. Nowadays, it is mostly used in the treatment of locally advanced rectal cancer and recurrent rectal cancer. Total pelvic organ removal surgery includes removal of the entire tumor and the distal sigmoid colon and rectum, bladder, distal ureter, and male reproductive organs (seminal vesicles, prostate) or female reproductive organs (uterus, vagina). The total pelvic combined organ resection surgery is large in scope, bleeding, and requires double urinary and fecal diversion, which is currently the most difficult and complex surgery in the field of gastrointestinal surgery, and is only carried out in a few hospitals at present. The Department of General Surgery of Peking University Hospital has completed more than 30 cases of pelvic organ resections each year since the first case of total pelvic organ resection in 1989, and has completed more than 200 cases of the operation so far. On the basis of the accumulated experience of open surgery, we successfully completed laparoscopic-assisted total pelvic organ resection in a patient with primary rectal cancer and primary bladder cancer and a patient with prostate sarcoma invading into the rectum, and all of them recovered smoothly and were discharged from the hospital safely, with a good result in the near future.CASE 1Patient, a male, 57 years old, was diagnosed with bladder cancer for 3 years and recurrence after TUR-Bt surgery. The patient was admitted to the hospital for “bladder cancer for 3 years, recurrence for 3 months after TUR-Bt surgery, and blood in stool for 1 month”. The patient was diagnosed with bladder cancer 3 years ago due to hematuria and underwent TUR-Bt. One year ago, hematuria reappeared and bladder cancer recurrence was considered, and TUR-Bt was performed again. A month ago, blood in the stool appeared, and a colonoscopy showed rectal cancer. Examination: knee-chest position 3cm from anus, ulcerated tumor on the posterior wall, size about 4×4×2cm. Diagnosis and treatment: rectal cancer, recurrent bladder cancer, abdominal CT, pelvic MRI, etc. After admission, preoperative staging suggested rectal cancer (T2N0M0), recurrent bladder cancer (T3N0M0). Sigmoid fistula was performed under general anesthesia; the operation went smoothly, and the postoperative recovery was good without complications. Postoperative pathology was ulcerated moderately differentiated adenocarcinoma of the rectum, 3.5×3.5×1, invading the deep muscular layer, and the surgical distal and proximal margins and peripheral margins were all negative, with lymph nodes 0/20, and the left side of the posterior wall of the bladder had nodular high-grade invasive uroepithelial carcinoma of the urogenital epithelial cancer, measuring 3×2.5×2cm, infiltrating the deep muscular layer, and involving the ureteral orifice, and the comprehensive considerations were Rectal cancer and bladder cancer were considered as double primary cancers. Figure 1 MRI showed double primary cancers of rectum and bladder Figure 2 Comparison between laparoscopy and traditional incision Figure 3 Surgical specimen CASE 2 Patient, male, 62 years old, was admitted to the hospital with the main cause of “rectal mass with difficulty in defecation for 1 month, 5 months after radical prostatectomy”. Diagnosis: postoperative recurrence of prostate sarcoma and invasion of rectal cancer. Diagnosis and treatment: after admission, complete abdominal CT, pelvic MRI and other examinations were carried out, and laparoscopic assisted total pelvic organ resection and ureteral skin stoma were performed under general anesthesia. Personal experience: 1. 8 hours of surgery on average, intraoperative bleeding of 300 ml; 2. reasonable selection of cases, laparoscopic total pelvic organ resection is operable; 3. surgical bleeding is significantly smaller than open surgery, postoperative recovery is faster, no postoperative complications, the advantages of laparoscopy in the near future are more obvious.