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Journal of Minimally Invasive Gynecology, Vol 12, No 5, September/October Supplement 2005
FRIDAY, NOVEMBER 11, 2005 (4:27 PM– 4:33 PM) Open Communications 6 —Operative Laparoscopy 279 The Role of Robotic-Assisted Laparoscopy in Gynecological Surgeries Saberi NS, Shahmohamady B, Nezhat CH, Nezhat F, Nezhat C. Foster City, California; Palo Alto, California; Palo Alto, California; Palo Alto, California; The Center for Minimally Invasive Surgery, Palo Alto, California Study Objective: To evaluate the role of robotic-assisted laparoscopy in gynecological surgeries Design: Retrospective study Setting: Tertiary referral center Patients: Women of different age group who were undergoing laparoscopy surgeries Intervention: In a tertiary referral center for laparoscopic gynecological surgery, a total of 15 patients who were undergoing various gynecologic surgeries were consented for combined laparoscopic and robotic-assisted laparoscopic surgery. The da Vinci robot was used for each case. Four ports were inserted: umbilicus, suprapubic, and two lateral ports. These surgeries were performed both using laparoscopic and robotic-assisted laparoscopic techniques. Measurements and Main Results: Fifteen patients underwent a variety of gynecologic surgeries such as myomectomies, treatment of endometriosis, total and supracervical hysterectomy, ovarian cystectomy, sacral colpopexy and Moskowitz procedure. The assembly time to switch from laparoscopy to robotic assisted surgery was 18.9 minutes (14-27 minutes), and the disassembly time was 2.1 minutes (1–3 minutes). Robotic assisted surgery was used for suturing after myomectomy, tissue manipulation, suturing of cervical stump after supracervical hysterectomy, vaginal cuff closure and suspension after total laparoscopic hysterectomy, ovarian suturing after cystectomy and performing Moskowitz procedure. Conclusion: Robotic-assisted laparoscopic surgeries have advantages in providing a 3 dimensional visualization of operative field, decreasing fatigue and tension tremor of surgeon, and added wrist motion for improved dexterity and greater surgical precision. The disadvantages include enormous cost and added operating time for assembly and disassembly. The greatest practical use lies in the ability to perform easier suturing in laparoscopic surgery. FRIDAY, NOVEMBER 11, 2005 (3:45 PM) Open Communications 7—Endometriosis 280 Endometriosis in Women with Symptomatic Leiomyomata Saberi NS. Foster City, California Study Objective: To determine the presence of endometriosis in patients with symptomatic leiomyomata
Design: Retrospective study. Setting: Tertiary referral endoscopic center. Patients: Premenopausal patients with symptomatic fibroid. Intervention: This was a retrospective chart review from January 2002 through June 2004 from a tertiary referral endoscopic center. Premenopausal patients were selected who had symptomatic leiomyomata and were candidates for surgical therapy. Patients underwent laparoscopic myomectomy or laparoscopic assisted myomectomy. Patients were included if they had symptoms such as pressure, menorrhagia, pelvic pain, or dysmenorrhea, with ultrasound findings or operative findings consistent with significant leiomyomata. Endometriosis was verified by biopsy or laparoscopic inspection and photographic documentation by an experienced surgeon. Measurements and Main Results: A total of 32 patients met the inclusion criteria. Average age was 40.5 (27–50) years. The sizes of leiomyomata were reported either as weight in grams or in dimensions of the collective morcellated leiomyomata. Among 25 patients the average weight of the leiomyomata was 319 g (35–1650g). The remaining 7 patients had size reported as the dimensions of the collective morcellated leiomyomata, which were on average 9.4x8.5 cm. Twenty-seven of the 32 (84%) patients were found to have concurrent endometriosis. All 27 patients had photographic documentation. Fourteen of the 27 patients had excisional biopsy confirming endometriosis. Conclusion: Our data suggest that a high percentage of patients with leiomyomata have endometriosis. 281 Identification of Remarkable Complication during Retroperitoneal Laparoscopic Lymphadenectomy against Gynecologic Cancer Sasaki H, Hoshiba T, Asamoto A, Hirabuki SY, Ishikawa H, Yoshinari H, Saitoh R. Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan Study Objective: To identify procedure-specific complication during retroperitoneal laparoscopic lymphadenectomy, and to discuss the safety measure against those complications. Design: Retrospective review of 86 cases with gynecologic cancer who underwent retroperitoneal laparoscopic paraaortic/pelvic lymphadenectomy. Setting: Urban group practice in Kanazawa, Japan. Patients: Eighty-six women who required para-aortic/pelvic lymphadenectomy due to gynecologic cancer. Intervention: Retroperitoneal laparoscopic para-aortic/pelvic lymphadenectomy. Measurements and Main Results: Four cases were unexpectedly required laparotomy. Two pneumothoraces were found during retroperitoneal lymphadenectomy, and these were seemed to be independent to the learning curve. Sudden drop of SpO2 was the initial sign on diagnosis of
Journal of Minimally Invasive Gynecology, Vol 12, No 5, September/October Supplement 2005
FRIDAY, NOVEMBER 11, 2005 (4:27 PM– 4:33 PM) Open Communications 6 —Operative Laparoscopy 279 The Role of Robotic-Assisted Laparoscopy in Gynecological Surgeries Saberi NS, Shahmohamady B, Nezhat CH, Nezhat F, Nezhat C. Foster City, California; Palo Alto, California; Palo Alto, California; Palo Alto, California; The Center for Minimally Invasive Surgery, Palo Alto, California Study Objective: To evaluate the role of robotic-assisted laparoscopy in gynecological surgeries Design: Retrospective study Setting: Tertiary referral center Patients: Women of different age group who were undergoing laparoscopy surgeries Intervention: In a tertiary referral center for laparoscopic gynecological surgery, a total of 15 patients who were undergoing various gynecologic surgeries were consented for combined laparoscopic and robotic-assisted laparoscopic surgery. The da Vinci robot was used for each case. Four ports were inserted: umbilicus, suprapubic, and two lateral ports. These surgeries were performed both using laparoscopic and robotic-assisted laparoscopic techniques. Measurements and Main Results: Fifteen patients underwent a variety of gynecologic surgeries such as myomectomies, treatment of endometriosis, total and supracervical hysterectomy, ovarian cystectomy, sacral colpopexy and Moskowitz procedure. The assembly time to switch from laparoscopy to robotic assisted surgery was 18.9 minutes (14-27 minutes), and the disassembly time was 2.1 minutes (1–3 minutes). Robotic assisted surgery was used for suturing after myomectomy, tissue manipulation, suturing of cervical stump after supracervical hysterectomy, vaginal cuff closure and suspension after total laparoscopic hysterectomy, ovarian suturing after cystectomy and performing Moskowitz procedure. Conclusion: Robotic-assisted laparoscopic surgeries have advantages in providing a 3 dimensional visualization of operative field, decreasing fatigue and tension tremor of surgeon, and added wrist motion for improved dexterity and greater surgical precision. The disadvantages include enormous cost and added operating time for assembly and disassembly. The greatest practical use lies in the ability to perform easier suturing in laparoscopic surgery. FRIDAY, NOVEMBER 11, 2005 (3:45 PM) Open Communications 7—Endometriosis 280 Endometriosis in Women with Symptomatic Leiomyomata Saberi NS. Foster City, California Study Objective: To determine the presence of endometriosis in patients with symptomatic leiomyomata
Design: Retrospective study. Setting: Tertiary referral endoscopic center. Patients: Premenopausal patients with symptomatic fibroid. Intervention: This was a retrospective chart review from January 2002 through June 2004 from a tertiary referral endoscopic center. Premenopausal patients were selected who had symptomatic leiomyomata and were candidates for surgical therapy. Patients underwent laparoscopic myomectomy or laparoscopic assisted myomectomy. Patients were included if they had symptoms such as pressure, menorrhagia, pelvic pain, or dysmenorrhea, with ultrasound findings or operative findings consistent with significant leiomyomata. Endometriosis was verified by biopsy or laparoscopic inspection and photographic documentation by an experienced surgeon. Measurements and Main Results: A total of 32 patients met the inclusion criteria. Average age was 40.5 (27–50) years. The sizes of leiomyomata were reported either as weight in grams or in dimensions of the collective morcellated leiomyomata. Among 25 patients the average weight of the leiomyomata was 319 g (35–1650g). The remaining 7 patients had size reported as the dimensions of the collective morcellated leiomyomata, which were on average 9.4x8.5 cm. Twenty-seven of the 32 (84%) patients were found to have concurrent endometriosis. All 27 patients had photographic documentation. Fourteen of the 27 patients had excisional biopsy confirming endometriosis. Conclusion: Our data suggest that a high percentage of patients with leiomyomata have endometriosis. 281 Identification of Remarkable Complication during Retroperitoneal Laparoscopic Lymphadenectomy against Gynecologic Cancer Sasaki H, Hoshiba T, Asamoto A, Hirabuki SY, Ishikawa H, Yoshinari H, Saitoh R. Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan Study Objective: To identify procedure-specific complication during retroperitoneal laparoscopic lymphadenectomy, and to discuss the safety measure against those complications. Design: Retrospective review of 86 cases with gynecologic cancer who underwent retroperitoneal laparoscopic paraaortic/pelvic lymphadenectomy. Setting: Urban group practice in Kanazawa, Japan. Patients: Eighty-six women who required para-aortic/pelvic lymphadenectomy due to gynecologic cancer. Intervention: Retroperitoneal laparoscopic para-aortic/pelvic lymphadenectomy. Measurements and Main Results: Four cases were unexpectedly required laparotomy. Two pneumothoraces were found during retroperitoneal lymphadenectomy, and these were seemed to be independent to the learning curve. Sudden drop of SpO2 was the initial sign on diagnosis of