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Laparoscopic Radical Trachelectomy for Young Women with Early Stage Cervical Cancer
Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159
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Medial Ovarian Transposition for Functional Protection in a Woman with Radiation Therapy Sola V, Ricci P, Pardo J. Obstetrics and Gynecology, Clinica Las Condes, Santiago, Chile
Robotic Assisted Laparoscopic Total Pelvic Exenteration Nezhat FR, Hagopian G, Peresic D, Bradley W, Liu CS. Obstetrics, Gynecology, and Reproductive Health, Mount Sinai Medical Center, New York, New York
There are reports in the literature about lateral ovarian transposition to preserve ovarian function previous to radiotherapy. In cases of young women with bilateral compromised parailiac ganglia a laparoscopic ovarian transposition towards a retro uterine location out of the reach of the main radiation beam can be made. This video shows the details of the surgical technique. The proximal pole of both ovaries was fixed to the ipsilateral uterosacral ligament. Two metallic clips were used to mark each distal ovarian pole to verify final position with x-rays. Preservation of the ovarian function was documented by hormonal levels and menstruation patterns.
Objective: To present a video demonstration of robotic assisted laparoscopic total pelvic exenteration. Methods: A 56-year-old with a history of stage IIA cervical cancer status post chemotherapy and radiation presented with a central recurrence. Results: Robotic assisted laparoscopic total pelvic exenteration was performed with paraaortic and pelvic lymphadenectomy, rectosigmoid colon reanastamosis, diverting ileostomy, and Miami pouch reconstruction. Conclusion: Robotic assisted laparoscopic total pelvic exenteration is a feasible surgical approach to treat central recurrent cervical cancer.
567 ONCOLOGY 564 Laparoscopic Feasibility of Nerve-Sparing Radical Hystrectomy and Trachelectomy in Patients with Cervical Cancer: Preliminary Results and Efforts To Increase Radicality Kim DY, Roh HJ, Lee SW, Park JY, Cho YH, Seo DS, Kim JH, Kim YM, Kim YT, Nam JH. Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea The aim of this study was to describe a technique for preserving the autonomic nerves including hypogastric nerves, pelvic splanchnic nerves, pelvic plexus and its vesical branches during type III laparoscopic radical hystrectomy(LRH) and trachelctomy(LRT) and to evaluate postoperative bladder function in these patients. Nerve-sparing LRH and LRT were performed in consecutive 11 patients with early stage cervical cancer from 2006 to 2008. Bilateral hypogastric nerves and vesical branches of pelvic splanchnic nerves were preserved in 4 cases in both sides and 7 cases in only left side. Urinary drainage was removed six days after surgery in all patients.The amount of residial urine was less than 50 ml in all patients before 9th day after surgery. Only one patients suffered from bladder dysfunction after discharge untill now. Nervesparing LRH and LRT could be effective procedure for preservation bladder function in patients with early satge cervical cancer without compromising radicality.
565 Laparoscopic Radical Trachelectomy for Young Women with Early Stage Cervical Cancer Kim JH, Park JY, Kim DY, Kim YM, Kim YT, Nam JH. Obstetrics and Gynecology, Asan Medical Center, Seoul, Republic of Korea Radical hysterectomy has been the standard treatment for early stage cervical cancer. However, for young women with early stage cervical cancer who wish to preserve their fertility, radical hysterectomy is not acceptable. Laparoscopic-assisted vaginal radical trachelectomy (LAVRT) was therefore introduced for these patients as an alternative to radical hysterectomy. After the first description by Dargent and colleagues, over 500 cases of utilization of this technique have been reported in the literature, with over 100 live births reported after the procedure. In LAVRT, the shortcomings are 1) the difficulty of learning radical vaginal surgery, and 2) possible incomplete parametrial resection. As an alternative to LAVRT, laparoscopic radical trachelectomy (LRT) has been introduced. Sine 2004, 26 young women with early stage cervical cancer who wish to preserve their fertility underwent LRT in our center. In this presentation, we introduce surgical technique of LRT for young women with cervical cancer.
Fertility Sparing Robotic-Assisted Radical Trachelectomy and Bilateral Pelvic Lymphadenectomy in Early Stage Cervical Cancer Nezhat FR, Liu CS, Lerner D, Chuang L. Mount Sinai Medical Center, New York, New York This is a unique case of fertility sparing treatment of early stage cervical cancer in the form of robotic assisted radical trachelectomy. The advantages of robotics and how it may facilitate this complex procedure will be demonstrated. We hope that this may improve availability of this surgical treatment for young patients with early stage disease.
568 Abstract moved to 471.5
569 Laparoscopic Vault Excision Puntambekar SP, Kulkarni MA, Puntambekar SS, Patil AM, Wagh GN. Gynaecological Oncology, Galaxy Laparoscopy Institute, Pune, Maharashtra, India Introduction: Many a times, it is required to perform a vault excision for denovo or recurrent cancer of vagina. PURPOSE: To demonstrate the technique of laparoscopic vault excision in such patients. Intervention: We performed a laparoscopic vault excision in four patients having tumors of the vault of more than 3 cm (n 5 3, recurrence of cancer cervix, n 5 1, primary tumor of the vagina).In the absence of uterus,the bulk of the tumor is likely to invade the bladder earlier than in virgin cases. Identification of the vaginal stump and its dissection from the bladder is a critical step in such a surgery. This video depicts the technique of total vaginectomy in such patients where, the anatomy is distorted and preservation of bladder is difficult. It also emphasises the fact the laparoscopic vault excision though technically difficult, is easier than open surgery.
PELVIC PAIN 570 Extirpation of the Uterus Sacral Ligaments in Patients with Endometriosis and Chronic Pelvic Pain Dionisi HJ. Ginecologia, Instituto Oulton, Cordoba, Argentina Extirpation of the uterus sacral Ligaments are very useful for the treatment of the chronic pelvic pain associated with endometriosis. On the next video we show the technique details, on two cases, the first one in a stage two endometriosis patient and the other in a stage four one. On the first case we identified the ureter and we dissect it, then with monopolar cautery we
S155
563
566
Medial Ovarian Transposition for Functional Protection in a Woman with Radiation Therapy Sola V, Ricci P, Pardo J. Obstetrics and Gynecology, Clinica Las Condes, Santiago, Chile
Robotic Assisted Laparoscopic Total Pelvic Exenteration Nezhat FR, Hagopian G, Peresic D, Bradley W, Liu CS. Obstetrics, Gynecology, and Reproductive Health, Mount Sinai Medical Center, New York, New York
There are reports in the literature about lateral ovarian transposition to preserve ovarian function previous to radiotherapy. In cases of young women with bilateral compromised parailiac ganglia a laparoscopic ovarian transposition towards a retro uterine location out of the reach of the main radiation beam can be made. This video shows the details of the surgical technique. The proximal pole of both ovaries was fixed to the ipsilateral uterosacral ligament. Two metallic clips were used to mark each distal ovarian pole to verify final position with x-rays. Preservation of the ovarian function was documented by hormonal levels and menstruation patterns.
Objective: To present a video demonstration of robotic assisted laparoscopic total pelvic exenteration. Methods: A 56-year-old with a history of stage IIA cervical cancer status post chemotherapy and radiation presented with a central recurrence. Results: Robotic assisted laparoscopic total pelvic exenteration was performed with paraaortic and pelvic lymphadenectomy, rectosigmoid colon reanastamosis, diverting ileostomy, and Miami pouch reconstruction. Conclusion: Robotic assisted laparoscopic total pelvic exenteration is a feasible surgical approach to treat central recurrent cervical cancer.
567 ONCOLOGY 564 Laparoscopic Feasibility of Nerve-Sparing Radical Hystrectomy and Trachelectomy in Patients with Cervical Cancer: Preliminary Results and Efforts To Increase Radicality Kim DY, Roh HJ, Lee SW, Park JY, Cho YH, Seo DS, Kim JH, Kim YM, Kim YT, Nam JH. Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea The aim of this study was to describe a technique for preserving the autonomic nerves including hypogastric nerves, pelvic splanchnic nerves, pelvic plexus and its vesical branches during type III laparoscopic radical hystrectomy(LRH) and trachelctomy(LRT) and to evaluate postoperative bladder function in these patients. Nerve-sparing LRH and LRT were performed in consecutive 11 patients with early stage cervical cancer from 2006 to 2008. Bilateral hypogastric nerves and vesical branches of pelvic splanchnic nerves were preserved in 4 cases in both sides and 7 cases in only left side. Urinary drainage was removed six days after surgery in all patients.The amount of residial urine was less than 50 ml in all patients before 9th day after surgery. Only one patients suffered from bladder dysfunction after discharge untill now. Nervesparing LRH and LRT could be effective procedure for preservation bladder function in patients with early satge cervical cancer without compromising radicality.
565 Laparoscopic Radical Trachelectomy for Young Women with Early Stage Cervical Cancer Kim JH, Park JY, Kim DY, Kim YM, Kim YT, Nam JH. Obstetrics and Gynecology, Asan Medical Center, Seoul, Republic of Korea Radical hysterectomy has been the standard treatment for early stage cervical cancer. However, for young women with early stage cervical cancer who wish to preserve their fertility, radical hysterectomy is not acceptable. Laparoscopic-assisted vaginal radical trachelectomy (LAVRT) was therefore introduced for these patients as an alternative to radical hysterectomy. After the first description by Dargent and colleagues, over 500 cases of utilization of this technique have been reported in the literature, with over 100 live births reported after the procedure. In LAVRT, the shortcomings are 1) the difficulty of learning radical vaginal surgery, and 2) possible incomplete parametrial resection. As an alternative to LAVRT, laparoscopic radical trachelectomy (LRT) has been introduced. Sine 2004, 26 young women with early stage cervical cancer who wish to preserve their fertility underwent LRT in our center. In this presentation, we introduce surgical technique of LRT for young women with cervical cancer.
Fertility Sparing Robotic-Assisted Radical Trachelectomy and Bilateral Pelvic Lymphadenectomy in Early Stage Cervical Cancer Nezhat FR, Liu CS, Lerner D, Chuang L. Mount Sinai Medical Center, New York, New York This is a unique case of fertility sparing treatment of early stage cervical cancer in the form of robotic assisted radical trachelectomy. The advantages of robotics and how it may facilitate this complex procedure will be demonstrated. We hope that this may improve availability of this surgical treatment for young patients with early stage disease.
568 Abstract moved to 471.5
569 Laparoscopic Vault Excision Puntambekar SP, Kulkarni MA, Puntambekar SS, Patil AM, Wagh GN. Gynaecological Oncology, Galaxy Laparoscopy Institute, Pune, Maharashtra, India Introduction: Many a times, it is required to perform a vault excision for denovo or recurrent cancer of vagina. PURPOSE: To demonstrate the technique of laparoscopic vault excision in such patients. Intervention: We performed a laparoscopic vault excision in four patients having tumors of the vault of more than 3 cm (n 5 3, recurrence of cancer cervix, n 5 1, primary tumor of the vagina).In the absence of uterus,the bulk of the tumor is likely to invade the bladder earlier than in virgin cases. Identification of the vaginal stump and its dissection from the bladder is a critical step in such a surgery. This video depicts the technique of total vaginectomy in such patients where, the anatomy is distorted and preservation of bladder is difficult. It also emphasises the fact the laparoscopic vault excision though technically difficult, is easier than open surgery.
PELVIC PAIN 570 Extirpation of the Uterus Sacral Ligaments in Patients with Endometriosis and Chronic Pelvic Pain Dionisi HJ. Ginecologia, Instituto Oulton, Cordoba, Argentina Extirpation of the uterus sacral Ligaments are very useful for the treatment of the chronic pelvic pain associated with endometriosis. On the next video we show the technique details, on two cases, the first one in a stage two endometriosis patient and the other in a stage four one. On the first case we identified the ureter and we dissect it, then with monopolar cautery we