Comparison of Laparoscopic Versus Conventional Open Surgical Staging Procedure for Endometrial Cancer

Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S152–S177 Intervention: Laparoscopic staging for endometrial cancer performed by a gynecologic oncology fellow. Measurements and Main Results: Four fellows performed 124 laparoscopic or attempted laparoscopic staging procedures with 7 skilled attending surgeons. There was no statistical difference between the patients of each fellow in terms of age or prior abdominal surgery. The average BMI was 29.7 and was statistically different among fellows. As fellows gained operative experience, there was no statistical difference in operative time or estimated blood loss. An increase in nodal yields at the conclusion of fellowship was suggestive of a learning curve. There were 32 conversions from laparoscopy to laparotomy with no statistical difference among fellows or amongst experience level. Conclusion: Estimated blood loss and operative time are not predictive of proficiency in advanced laparoscopy. Nodal yields however may be useful as a marker of competency. Subjective assessment of a fellow’s surgical proficiency remains the standard method of evaluation, and a tangible measure of competency in advanced laparoscopic procedures still needs to be identified. 582 Laparoscopically Assisted Intra-Peritoneal Port Placement after Initial Debulking Surgery Janco JMT,2 Awtrey C.1 1Gynecologic Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; 2Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts Study Objective: To evaluate the safety and efficacy of laparoscopically assisted intraperitoneal port (IP) placement after initial debulking surgery for advanced ovarian, fallopian tube and peritoneal cancer. Design: Retrospective case series. Setting: Beth Israel Deaconess Medical Center, Boston, MA, USA. Patients: Thirty-three patients who had undergone debulking and staging surgery for advanced ovarian, fallopian tube and peritoneal cancer and who subsequently had an attempt at laparoscopically assisted IP port placement during the period of 2006-2009. Intervention: Laparoscopically assisted IP port placement after debulking surgery. Measurements and Main Results: Thirty-four patients were brought to the operating room for attempt at laparoscopically assisted IP port placement. 33/34 (97%) were successfully placed, and there were no conversions to open procedures. There were no intra-operative complications identified, although in one patient a subsequent bowel injury was noted within 24 hours of IP port placement. There were 2 IP port infections, requiring removal of the port, and there were six cases of port dysfunction; however, in 3 the port was replaced in a subsequent procedure and these patients were able to complete IP chemotherapy. Conclusion: Laparoscopically assisted IP port placement is safe, with complication rates comparable to IP port placement at time of initial debulking surgery. 583 Single-Port Laparoscopic Pelvic Lymph Node Dissection with Modified Radical Vaginal Hysterectomy in Cervical Cancer Kim Y-W. Department of Obstetrics and Gynecology, The Catholic University of Korea, Incheon St. Mary’s Hospital, Incheon, Republic of Korea Study Objective: We report two patients with cervical cancer, stage Ia2, who underwent single-port laparoscopic pelvic lymph node dissection (SPLPLND) with modified radical vaginal hysterectomy. Patients: \Case 1> A 50-year old woman, G 3, P 3, was referred to our department with moderately differentiated cervical squamous cell carcinoma, stage Ia2. Her body mass index was 21.4 kg/m2. We performed SPLPLND with modified RVH with bilateral adnexectomy. After surgery, the number of obtained lymph nodes was 24, with no lymph node invasion. The operative time was 165 minutes, and the Hb change was 2.8 g/dl. We removed the transumbilical drainage tube (Kim’s transumbilical drainage system) 5 days after surgery. She was

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discharged the same day and there were no post-operative complications. With follow-up for over a year, she is showing a normal post-operative course. \Case 2> A 52-year old woman, G 2, P 2, was diagnosed as a moderately differentiated cervical squamous cell carcinoma, stage Ia2. Her body mass index was 24.2 kg/m2. We performed SPLPLND with modified RVH with bilateral adnexectomy. After surgery, the number of obtained pelvic lymph nodes was 47, with no lymph node invasion. The Hb change was 2.7 g/dl and the operative time was 190 minutes. We removed the drainage tube 3 days after surgery. The patient was discharged 4 days after surgery and there were no complications. With follow-up for over a year, she is showing a normal post-operative course. Intervention: After performing a 1.5 to 2.0 cm umbilical incision, we inserted one laparoscope and two other instruments into three cannulas of the port created by a wound retractor and a surgical glove. The operation was executed with conventional rigid straight laparoscopic instruments. Conclusion: Combining either classic or modified Schauta radical vaginal hysterectomy with single-port laparoscopic technique, could be a good option for the management of patients with cervical cancer. 584 Comparison of Laparoscopic Versus Conventional Open Surgical Staging Procedure for Endometrial Cancer Kim WY, Chang S-J, Kong TW, Yoo S-C, Ryu H-S, Chang K-H, Cheong J-Y, Yoon J-H. Obsetetrics & Gynecology, Ajou University School of Medicine, Suwon, Kyung-Gi, Korea Study Objective: The aim of this study was to compare surgical outcomes of the laparoscopic surgery and conventional laparotomy for endometrial cancer. Design: Between March 2006 and June 2009, a total of 104 consecutive patients were non-randomly assigned either laparoscopic surgery or laparotomy. All patients underwent comprehensive surgical staging procedures including total hysterectomy, bilateral salpingo-oophorectomy, and pelvic/para-aortic lymphadenectomy. The safety, morbidity, and survival rates of the two groups were compared and data was prospectively analyzed according to intention-to-treat principle. Measurements and Main Results: Thirty-four patients had laparoscopic surgery and 70 had laparotomies. Operation time taken for the laparoscopic procedure was 227.0  28.8 min, which showed significant difference from the laparotomy group at 208.1  46.4 min (p=0.032). The estimated blood loss of patients undergoing laparoscopic surgery was 230.3  92.4 mL. This was significantly less than that of the laparotomy group (301.9  156.3 mL, p=0.015). The laparoscopic group had an average of 20.8 pelvic and 9.1 para-aortic nodes retrieved, as compared to 17.2 pelvic and 8.5 par-aortic nodes retrieved in the laparotomy group. There were no significant differences (p=0.062 and p=0.554). The mean hospitalization was significantly greater in the laparotomy group than the laparoscopic group (23.3 and 16.4 days, p\0.001). The incidence of postoperative complications was 15.7% and 11.8% in the laparotomy and laparoscopic groups respectively. No statistically significant difference was found between the two groups in the survival rate. Conclusion: Laparoscopic surgical staging operation is a safe and effective therapeutic procedure for management of endometrial cancer with an acceptable morbidity compared to the laparotomic approach and is characterized by far less blood loss and shorter postoperative hospitalization. Multicenter randomized trials with longer follow-up are necessary to evaluate the overall oncologic outcomes of this procedure. 585 Single-Port Laparoscopic Comprehensive Surgical Staging Operation in Endometrial Cancer: Initial Experience Kim Y-W. Department of Obstetrics and Gynecology, The Catholic University of Korea, Incheon St. Mary’s Hospital, Incheon, Republic of Korea Study Objective: Surgical staging operation in endometrial cancer includes pelvic lymph node dissection and paraaortic lymph node sampling with