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Robot-Assisted Laparoscopic Staging of Endometrial Cancer in Taiwan
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Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S1eS51 Video Session 3dOncology (2:31 PM d 2:39 PM)
Laparoscopic Vascular Injury Repair II during Pelvic Lymphadenectomy Andou M, Hada T, Takaki Y, Ohta Y, Miki M, Deura I, Kanao H. Gynecology, Kurashiki Medical Center, Kurashiki-shi, Okayama-ken, Japan Study Objective: Vascular injury is one of the most serious possible complications which can occur during pelvic lymphadenectomy. Two cases (one left external iliac artery and one right common iliac vein) which were repaired laparoscopically are presented. Materials and Methods: Temporary bleeding control is of paramount importance for accurate complication free repair. Tools and techniques for bleeding control as well as intracorporeal suturing skills will be shown. Results: Conversion to laparotomy was avoided. No vascular complications or edema occurred. Conclusion: Although technically demanding, intraoperative vascular repair allows the original laparoscopic pelvic lymphadenectomy to proceed thoroughly while keeping the surgery minimally invasive and therefore patient friendly.
85
Video Session 3dOncology (2:40 PM d 2:46 PM)
Laparoscopic Posterior Exenteration for Cervical Carcinoma Puntambekar SP. Gynaeconcology, Galaxy Laparoscopy Institute, Pune, Pune, MS, India Study Objective: To find out the feasibility of doing Laparoscopic posterior exenteration for cervical carcinoma. Methods: 6 patients with advanced cervical cancer, involving the rectum and no metastatic spread were considered for this procedure. All the patients underwent Laparoscopic posterior exenteration with either colorectal anastomosis or permanent colostomy. Result: These patients were evaluated for average hospitalization and overall morbidity. All the patients have completed 24 months follow-up. Permanent colostomy was performed in 3 patients and colorectal anastomosis in 4 patients. We had one leak, managed conservatively, 2 had wound infection and one had ileus. There was no morality. None of the patients required conversion to open surgery. The average hospitalization was 4 days. Conclusion: Contagious organ involvement is not a contraindication to a laparoscopic procedure. Laparoscopic posterior exenteration is feasible. Oncological safety needs to be further assessed.
86
Video Session 3dOncology (2:47 PM d 2:55 PM)
Laparoscopic Interval Debulking Surgery in Ovarian Cancer Choi JS,1 Lee JH,1 Jung US.2 1Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; 2Department of Obstetrics and Gynecology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Republic of Korea Study Objective: We report a videoclip of laparoscopic interval debulking surgery in ovarian cancer patient. She was transferrd to our institution due to advanced cancer of unknown origin. After diagnostic laparoscopy including laparoscopic BSO, appendectomy, mutile peritoneal biopsies, and peritoneal cytology, we made a decision initial chemotherapy becasue there were al lot of tiny metastatic nodules on the peritoneum and mesemtery. She received six cycles of paclitaxel-carboplatin, and then we performed a successful laparoscopic interval debulking surgery including peritoneal washing cytology, laparoscopic extraperitoneal hysterectomy, both laparoscopic pelvic lymphadenectomy, laparoscopic para-aortic lymphadenectomy, laparoscopic omentectomy, and mutiple peritoneal biopsies. She is healthy after more three cycles of chemotherapy.
87
Video Session 3dOncology (2:56 PM d 3:01 PM)
Laparoscopic Technique of Para-Aortic High-Level Lymphadenectomy for Endometrial Cancer Shih CL,1,2 Lin WW-C,1,2 Chang CY-Y,1,2 Yeh LS,1,2 Hung Y-C.1,2 1OBS/ GYN, China Medical University Hospital, Taichung, Taiwan Republic of China; 2Taiwan Association for Minimally Invasive Gynecology, Taiwan Republic of China Study Objective: To assess the efficacy and safety procedure of laparoscopic staging procedure in endometrical cancer, that increasing incidence. Design: Make the technique of laparoscopic staging operation safe, easy to approach high-level paraaortic lymphadenectomy. Setting: China Medical University Hospital in Taiwan, Obs & Gyn department. Patients: 61 y/o, persist vaginal spotting for 2 months. Fractional D&C revealed endometrioid adenocarcinoma grade II. Interventions: Laparoscopic staging operation without ruptured the tumor, en-block dissection of lymphnodes, remove the specimen with tissue bag, coloptomy vaginally. Measurements and Main Results: The operation time of laparoscopic surgery is similar to laparotomy, but less blood loss, significantly shorter hospital stay and less wound pain. Conclusions: Laparoscopic staging operation for the endometrial cancer is safe and effective.
88
Video Session 3dOncology (3:02 PM d 3:10 PM)
Robot-Assisted Laparoscopic Staging of Endometrial Cancer in Taiwan Han CM, Lee CL, Su H, Wang CJ, Yen CF. Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital & Chang Gung University College of Medicine, Taoyuan, Taiwan Republic of China Study Objective: The objective of the study was to evaluate perioperative and early postoperative outcomes of a robotic surgery program in endometrial cancer. Materials and Methods: The surgeries were performed with the da Vinci system (Intuitive Surgical, Inc.). We collect data retrospectively including docking times, operative times, estimated blood loss, length of hospital stay, lymph node yields, and complications. Results: Six patients with early-stage endometrial cancer underwent robotic-assisted staging laparoscopy from July 2007 to August 2008. The median lymph node count was 24.8 (range, 9 to 30). Mean operating time was 200 minutes (range, 143 to 261). The average estimated blood loss was 178 mL. No conversion was required, no intraoperative or postoperative complications occurred. All patients in this group were alive and free of disease at the time of last follow-up. To date, we are the first institute to perform robotically-assisted staging laparoscopy for endometrial cancer in Taiwan.
89
Open Communications 5dLaparoscopy (3:20 PM d 3:25 PM)
Obesity and Gynecologic Laparoscopy: Is There an Increased Risk of Complication? Green MA, Della Badia C. Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA Study Objective: Compare the risk of complication of women undergoing a major gynecologic laparoscopic procedure between obese versus nonobese women, as defined by Body Mass Index. Design: Retrospective chart review of patients who underwent a major gynecologic laparoscopic procedure between Jan 1-Dec 31, 2008. Setting: Academic urban institution. Patients: 111 women studied, 58% were non-obese (BMI ! 30) and 42% were obese (BMI O 30). Intervention: Women were divided by BMI into 2 cohorts, obese and nonobese. They were further stratified into categories based upon BMI classification. Outcomes included estimated blood loss, length of
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S1eS51 Video Session 3dOncology (2:31 PM d 2:39 PM)
Laparoscopic Vascular Injury Repair II during Pelvic Lymphadenectomy Andou M, Hada T, Takaki Y, Ohta Y, Miki M, Deura I, Kanao H. Gynecology, Kurashiki Medical Center, Kurashiki-shi, Okayama-ken, Japan Study Objective: Vascular injury is one of the most serious possible complications which can occur during pelvic lymphadenectomy. Two cases (one left external iliac artery and one right common iliac vein) which were repaired laparoscopically are presented. Materials and Methods: Temporary bleeding control is of paramount importance for accurate complication free repair. Tools and techniques for bleeding control as well as intracorporeal suturing skills will be shown. Results: Conversion to laparotomy was avoided. No vascular complications or edema occurred. Conclusion: Although technically demanding, intraoperative vascular repair allows the original laparoscopic pelvic lymphadenectomy to proceed thoroughly while keeping the surgery minimally invasive and therefore patient friendly.
85
Video Session 3dOncology (2:40 PM d 2:46 PM)
Laparoscopic Posterior Exenteration for Cervical Carcinoma Puntambekar SP. Gynaeconcology, Galaxy Laparoscopy Institute, Pune, Pune, MS, India Study Objective: To find out the feasibility of doing Laparoscopic posterior exenteration for cervical carcinoma. Methods: 6 patients with advanced cervical cancer, involving the rectum and no metastatic spread were considered for this procedure. All the patients underwent Laparoscopic posterior exenteration with either colorectal anastomosis or permanent colostomy. Result: These patients were evaluated for average hospitalization and overall morbidity. All the patients have completed 24 months follow-up. Permanent colostomy was performed in 3 patients and colorectal anastomosis in 4 patients. We had one leak, managed conservatively, 2 had wound infection and one had ileus. There was no morality. None of the patients required conversion to open surgery. The average hospitalization was 4 days. Conclusion: Contagious organ involvement is not a contraindication to a laparoscopic procedure. Laparoscopic posterior exenteration is feasible. Oncological safety needs to be further assessed.
86
Video Session 3dOncology (2:47 PM d 2:55 PM)
Laparoscopic Interval Debulking Surgery in Ovarian Cancer Choi JS,1 Lee JH,1 Jung US.2 1Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; 2Department of Obstetrics and Gynecology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Republic of Korea Study Objective: We report a videoclip of laparoscopic interval debulking surgery in ovarian cancer patient. She was transferrd to our institution due to advanced cancer of unknown origin. After diagnostic laparoscopy including laparoscopic BSO, appendectomy, mutile peritoneal biopsies, and peritoneal cytology, we made a decision initial chemotherapy becasue there were al lot of tiny metastatic nodules on the peritoneum and mesemtery. She received six cycles of paclitaxel-carboplatin, and then we performed a successful laparoscopic interval debulking surgery including peritoneal washing cytology, laparoscopic extraperitoneal hysterectomy, both laparoscopic pelvic lymphadenectomy, laparoscopic para-aortic lymphadenectomy, laparoscopic omentectomy, and mutiple peritoneal biopsies. She is healthy after more three cycles of chemotherapy.
87
Video Session 3dOncology (2:56 PM d 3:01 PM)
Laparoscopic Technique of Para-Aortic High-Level Lymphadenectomy for Endometrial Cancer Shih CL,1,2 Lin WW-C,1,2 Chang CY-Y,1,2 Yeh LS,1,2 Hung Y-C.1,2 1OBS/ GYN, China Medical University Hospital, Taichung, Taiwan Republic of China; 2Taiwan Association for Minimally Invasive Gynecology, Taiwan Republic of China Study Objective: To assess the efficacy and safety procedure of laparoscopic staging procedure in endometrical cancer, that increasing incidence. Design: Make the technique of laparoscopic staging operation safe, easy to approach high-level paraaortic lymphadenectomy. Setting: China Medical University Hospital in Taiwan, Obs & Gyn department. Patients: 61 y/o, persist vaginal spotting for 2 months. Fractional D&C revealed endometrioid adenocarcinoma grade II. Interventions: Laparoscopic staging operation without ruptured the tumor, en-block dissection of lymphnodes, remove the specimen with tissue bag, coloptomy vaginally. Measurements and Main Results: The operation time of laparoscopic surgery is similar to laparotomy, but less blood loss, significantly shorter hospital stay and less wound pain. Conclusions: Laparoscopic staging operation for the endometrial cancer is safe and effective.
88
Video Session 3dOncology (3:02 PM d 3:10 PM)
Robot-Assisted Laparoscopic Staging of Endometrial Cancer in Taiwan Han CM, Lee CL, Su H, Wang CJ, Yen CF. Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital & Chang Gung University College of Medicine, Taoyuan, Taiwan Republic of China Study Objective: The objective of the study was to evaluate perioperative and early postoperative outcomes of a robotic surgery program in endometrial cancer. Materials and Methods: The surgeries were performed with the da Vinci system (Intuitive Surgical, Inc.). We collect data retrospectively including docking times, operative times, estimated blood loss, length of hospital stay, lymph node yields, and complications. Results: Six patients with early-stage endometrial cancer underwent robotic-assisted staging laparoscopy from July 2007 to August 2008. The median lymph node count was 24.8 (range, 9 to 30). Mean operating time was 200 minutes (range, 143 to 261). The average estimated blood loss was 178 mL. No conversion was required, no intraoperative or postoperative complications occurred. All patients in this group were alive and free of disease at the time of last follow-up. To date, we are the first institute to perform robotically-assisted staging laparoscopy for endometrial cancer in Taiwan.
89
Open Communications 5dLaparoscopy (3:20 PM d 3:25 PM)
Obesity and Gynecologic Laparoscopy: Is There an Increased Risk of Complication? Green MA, Della Badia C. Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA Study Objective: Compare the risk of complication of women undergoing a major gynecologic laparoscopic procedure between obese versus nonobese women, as defined by Body Mass Index. Design: Retrospective chart review of patients who underwent a major gynecologic laparoscopic procedure between Jan 1-Dec 31, 2008. Setting: Academic urban institution. Patients: 111 women studied, 58% were non-obese (BMI ! 30) and 42% were obese (BMI O 30). Intervention: Women were divided by BMI into 2 cohorts, obese and nonobese. They were further stratified into categories based upon BMI classification. Outcomes included estimated blood loss, length of