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The Study of Staging Laparoscopy for Cervical Cancer
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Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159
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Laparoscopic Splenectomy for Solitary Splenic Recurrence of Ovarian Cancer Choi JH,1 Shin DG.2 1Obstetric and Gynecology, Seoul Medical Center, Seoul, Republic of Korea; 2Surgery, Seoul Medical Center, Seoul, Republic of Korea
Robotic Surgery Practice and Training in Gynecologic Oncology Frumovitz M, Greer M, Soliman PT, Schmeler KM, Moroney J, Ramirez PT. M.D. Anderson Cancer Center
Study Objective: Soliatry parenchymal splenic recurrence of ovarian carcinoma is rare. We report a case of a 60-year-old woman who presented with solitary splenic metastsis after 5-year disease-free period. Patients: This report presents a patient in whom a solitary splenic metastsis was detected 5 years after diagnosis of stage IIIa ovarian cancer. The patient was a 54-year-old woman who was diagnosed with stage IIIa ovarian serous papillary cystadenocarcinoma in 2002. She underwent six-cycles postoperative chemotherapy, and exhibited no signs of recurrence in terms of clinical symptoms, tumor markers and imaging findings. In 2007, Her CA 125 was normal range and her clinical symptoms, pelvic examination was unremarkable. but, routine CT scan of pelvic and abdomen showed 3 ) 2.5 cm lobulating contour splenic lesion that was not evident on previous CT scans. Also, PET-CT scan of whole body suggested hypermetabolic lesion at spleen. Measurements and Main Results: After penumococcal vaccination, she underwent laparoscopic splenectomy and microscopy confirmed the splenic tumor to be of the same histologic type as the ovarian cancer. She received six cycles of paclitaxel-carboplatin. At present, she remains disease-free 8 months after the surgery. Conclusion: Solitary splenic metastasis occurs relatively rarely in ovarian cancer. Laparoscopic splenectomy is a proper therapeutic modality for an isolated splenic metastasis form ovarian cancer.
477 A Rare Case of Clear Cell Cystadenofibroma of Ovary Choi JH, Suh MJ, Park DC. OB-Gyn, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Republic of Korea Study Objective: Most clear cell tumors of the ovaries are carcinomas; benign and borderline clear cell tumors are uncommon. We describe here an ovarian clear cell cystadenofibroma that was misdiagnosed before laparoscopic surgery as a borderline malignant cystic mass of the ovary. Patients: A 52-year-old woman presented with a painless palpable mass in her left lower quadrant abdomen. Serum concentrations of the tumor markers CA-125 and CA19-9 were 22.1 ng/mL and 15.0 ng/mL, respectively. Computed tomography showed a cystic tumor, approximately 7.7x6.0x5.9 cm in size, with a distinct border in the left adnexa. A high density area with enhanced contrast was observed in the front area of the tumor, suggesting a borderline malignant ovarian tumor. Measurements and Main Results: The patient underwent laparoscopic surgery, with all procedures performed in an endo-pouch. The tumor was generally round and hard, with papillary growing nodules at the surface. A blue-gray cyst approximately 7 cm in size and with a distinct border was observed in the left ovary. After aspiration of dark brown serous cystic fluid, a gray-brown hard solid area approximately 3x4 cm in size remained. The tumor was removed through the trocar port. Macroscopically, we observed a gray-brown solid mass approximately 3x4 cm in size before destruction of the capsule. The cross-sectioned tumor was pale gray-white in color, with several small cystic structures, giving it a beehive-like appearance. Histologically, we observed a dilated gland surrounded by fibrous matrix consisting of spindle cells, as well as epithelium lined by hobnail cells, squamous cells, and clear cells but no evidence of dysplasia or mitosis. The tumor was ultimately diagnosed as a clear cell cystadenofibroma. Conclusion: Laparoscopic surgery using endo pouch for ovarian tumor is safe and effective even in case of suspicious borderline malignancy.
Study Objective: To determine the proportion of gynecologic oncologists performing robotic surgery and to determine the level of fellows’ training in robotic surgery. Design: Survey administered by mail or internet in 2007. Patients: Full or candidate members of the Society of Gynecologic Oncologists. Measurements and Main Results: Three hundred forty-nine (39%) of SGO members responded. Currently, only 27% utilize the robot in their practice. Reasons for not using the robot included: hospital does not own a robotic system (32%); capable of performing all procedures with traditional laparoscopy (22%); robot limits laparoscopic exposure for trainees (9%). Among robot users, 19% utilize it for more than 75% of their laparoscopic cases while 55% use it for less than 25% of their minimally-invasive surgeries. Thirty-seven percent felt the robot was appropriate for hysterectomy/staging in endometrial cancer, 33% felt it appropriate for radical hysterectomy/pelvic lymphadenectomy, and 15% as a diagnostic instrument for adnexal masses. For procedures that respondents do not perform with traditional laparoscopy, 17% are able to perform laparoscopic radical hysterectomy and 10% perform hysterectomy/staging for endometrial cancer using the robot. Two-thirds of respondents thought their use of the robot would increase in the next year while an additional 15% stated that although they do not currently utilize it, they were planning on beginning. For those respondents who train fellows, 75% allow the fellow to sit at the console although 73% do so in less than half their cases. For those who train residents, only 30% allow them to sit at the console although 79% do so in less than half their cases. Conclusion: Gynecologic oncologists are embracing robotic surgery more quickly than they did traditional laparoscopy especially considering the limits of availability. Most SGO members plan to increase their usage in the next year.
479 The Study of Staging Laparoscopy for Cervical Cancer Funamoto H. Obsterics and Gynecology, Toyama Prefectural Central Hospital, Toyama, Japan Study Objective: To assess the efficacy of staging laparoscopy for cervical cancer. Design: Retrospective analysis of 38cases underwent staging laparoscopy. Setting: Toyama Prefectural Central Hospital. Patients: 38 patients with cervical cancer. Intervention: Laparoscopic para-aortic lymphadenectomy. Measurements and Main Results: From September 1998 to December 2007, thirty-eight patients underwent this procedure for cervical cancer. Preoperative evaluation according to the FIGO guidelines showed 7 patients in stage Ib, 4 in IIa, 16 in IIb, 10 in IIIb and 1 in IVa. Histopathologically, there were 28 cases of squamous carcinoma, 8 cases of adenocarcinoma and 2 cases of adenosquamous cell carcinoma. The mean estimated blood loss was 101 ml and the mean operative time was 129 minutes. The average number of para-aortic lymph nodes removed laparoscopically was 11.4. In one case, bleeding from the left ovarian artery necessitated blood transfusion, and no port site recurrence was observed. Microscopic metastasis of para-aortic lymph nodes was detected in 5 (16.7 %) out of 26 patients with negative findings by preoperative computed tomography, and only two (33.3%) out of the six suspicious cases by preoperative CT were actually positive by staging laparoscopy. Conclusion: Staging laparoscopy for cervical cancer is necessary to determine the surgical staging before main treatment and the range of radiation for any patients who need radiotherapy.
Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159 480 A Comparison of Robotically-Assisted and Open Radical Hysterectomy for Early Stage Cervical Cancer Hoekstra AV, Jairam-Thodla A, Berry E, Lurain JR, Buttin BM, Singh DK, Schink JC, Lowe MP. Obstetrics and Gynecology, Feinberg School of Medicine of Northwestern University, Chicago, Illinois Study Objective: To report a pilot series comparing perioperative outcomes of robotically-assisted radical hysterectomy with traditional open radical hysterectomy for early stage cervical cancer. Design: A prospective analysis of 10 patients undergoing radical hysterectomy for early stage cervical cancer over 6 months. Setting: An academic group practice with a fellowship training program in an urban area. Patients: 10 women with early stage cervical cancer. Intervention: Robotically-assisted radical hysterectomy or traditional open radical hysterectomy with pelvic lymphadenectomy. Measurements and Main Results: Ten patients who underwent radical hysterectomy for cervix cancer were identified in the first 6 months after the introduction of the robotic surgery program. Six patients underwent robotically-assisted (ROB) radical hysterectomy and 4 open (LAP) radical hysterectomy. Median age (40 vs. 42; p 5 0.39) did not differ between groups. BMI (30 vs. 26; p 5 0.084) was higher in the LAP vs. the ROB group, but the difference did not reach statistical significance. Stage (100% vs. 83% stage IB;p 5 0.6) and grade (75% vs. 50% grade 2/ 3;p 5 0.23) distributions did not differ between the LAP and ROB groups, respectively. The ROB group trended towards shorter median operating time (255 min vs. 285 min; p 5 0.39), although it did not reach significance. The ROB group had a highly significant decrease in EBL (75 mL vs. 725 mL; p 5 0.01). Median lymph node counts (22.5 vs. 22.0;p 5 0.67) did not differ between the LAP and ROB groups. Patients in the ROB groups had a significantly shorter median hospital stay (1 vs. 3 days;p 5 0.0034) when compared to the LAP group. The rate of robotic radical hysterectomy increased from 0% to 60% within 6 months of the introduction of the robotic surgery program. Conclusion: The introduction of a robotic surgery program significantly changed practice patterns at one gynecologic oncology fellowship training institution. Lower blood loss and shorter hospital stay were significant advantages of robotic surgery for patients undergoing radical hysterectomy in our pilot series.
481 Successful Laparoscopic Removal of Huge Ovarian Cyst (7,000cc) through Umbilical and Two 5mm Cannula Sites Kim Y-W. Obstetrics and Gynecology, College of Medicine, Catholic University of Korea, Incheon, Republic of Korea Study Objective: Laparoscopic management of huge ovarian tumor is rare and controversial, because of the possibility of malignancy and technical difficulties. We present a patent with huge ovarian cyst (7,000 cc) who underwent successful laparoscopic surgery. We just inserted three cannulas (10 mm umbilical and two 5 mm lower abdominal cannulas). After aspiration of its contents, cystectomy was performed and the cyst was extracted through umbilicus cannula site (15 mm). The postoperative course was uneventful. No intra-operative and post-operative complications were observed. With proper case selection, minimally invasive surgery can be performed safely and effectively in patients with extremely large ovarian cyst.
482 Multidimensional Assessment of the Learning Curve for Laparoscopic Lymphadenectomy in Patients with Gynecologic Malignancies: A Preliminary Report Kim WY,1 Chang SJ,1 Ji YI,2 Yoon JH,1 Yoo SC,1 Chang KH,1 Ryu HS.1 1 Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Gyunggi-do, Republic of Korea; 2Obstetrics and Gynecology, Cheongju St. Mary’s Hospital, Cheongju, Chungcheongbuk-do, Republic of Korea
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Study Objective: To define a multidimensional learning curve for laparoscopic lymphadenectomy in patients with gynecologic malignancies. Design: Prospective analysis of 25 cases of laparoscopic cancer surgery including lymphadenectomy. Setting: University Hospital. Patients: Twenty-five patients with gynecologic malignancies (10 cervical cancer, 13 endometrial cancer, and 2 ovarian cancer). Intervention: Laparoscopic cancer surgery including pelvic and para-aortic lymphadenectomy. Measurements and Main Results: One surgeon, who had completed a 2-year fellowship courses on gynecologic cancer surgery in two university hospitals, performed all procedures. The moving average method was used to demonstrate the change of the operation time for lymphadenectomy. Cumulative sum method was used to analyze the changes in the total number of retrieved lymph nodes, laparotomy conversion, and complications. The operation time decreased from 165.9 minutes to 145.0 minutes after 10 operations. The number of retrieved lymph nodes (O 11) and complications were reached to a steady state after 12 consecutive procedures (90% success rate). There was no laparotomy conversion. Conclusion: The assessment of learning curve should not be limited to measurement of a decrease in operation time, but should also include the optimal oncologic outcome (e.g., lymph node count), complications, and conversion rates. These data might be especially useful for those planning training programs in laparoscopic surgery.
483 Laparoscopic Management of Mu¨llerian Adenosarcoma e A Case Report Koh LW, Wong CN, Huang MH. Obstetrics and Gynecology, Show Chwan Memorial Hospital, Changhua, Taiwan Republic of China Study Objective: To report a case of mullerian adenosarcoma by performing LAVH and bilateral pelvic lymph node sampling. Design: A case report. Setting: Show Chwan Memorial Hospital. Patients: A 28-year-old, unmarried, sexually active, obese (BMI 38.3 kg/ m2) young girl was presented with irregular vaginal spotting noticed for 2 months after amenorrhea for 5 years. Intervention: Gynecologic vaginal speculum examination revealed fleshy with eroded surface, polypoid configuration mass protruded from cervical introitus. Transvaginal sonography denote increase in uterine size with heterogeneously thickened endometrium.Biopsy of the polypoid mass was performed at other medical center with histologic report of low grade Adenosarcoma. Laparoscopic surgical staging (LAVH, bilateral salpingoophorectomies, pelvic lymph node sampling and washing cytology) was planned on the basic of clinical assessment and preliminary histologic report. Measurements and Main Results: Total Operative time was 150 minutes and the volume of blood loss intraoperatively was 200 ml. Patient was discharge on fourth postoperative days. Macroscopically, the polypoid mass was arose from uterine fundus with intravaginal extension and the extension was limited to endometrium. Final histologic showed low grade adenosarcoma with negative lymph node and no myometrial invasion. Conclusion: A best approach for management of uterine adenosarcoma was yet to be defined; surgery, chemotherapy, radiotherapy and follow-up have all been elucidated. In our case, surgery with follow-up seem to be an appropriate course of action due to the early stage of this rare cancer.
484 Cardiac Migration of a Fractured Infusaport Catheter Treated with Anticoagulation Kotikela S, Malviya VK. OB-GYN, Providence Hospital, Southfeild, Michigan Study Objective: Dislodgement of mediport catheter is a rare but recognised complication of indwelling vascular catheters. We present a patient with nonretreivable fractured catheter which was firmly adherent
Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159
476
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Laparoscopic Splenectomy for Solitary Splenic Recurrence of Ovarian Cancer Choi JH,1 Shin DG.2 1Obstetric and Gynecology, Seoul Medical Center, Seoul, Republic of Korea; 2Surgery, Seoul Medical Center, Seoul, Republic of Korea
Robotic Surgery Practice and Training in Gynecologic Oncology Frumovitz M, Greer M, Soliman PT, Schmeler KM, Moroney J, Ramirez PT. M.D. Anderson Cancer Center
Study Objective: Soliatry parenchymal splenic recurrence of ovarian carcinoma is rare. We report a case of a 60-year-old woman who presented with solitary splenic metastsis after 5-year disease-free period. Patients: This report presents a patient in whom a solitary splenic metastsis was detected 5 years after diagnosis of stage IIIa ovarian cancer. The patient was a 54-year-old woman who was diagnosed with stage IIIa ovarian serous papillary cystadenocarcinoma in 2002. She underwent six-cycles postoperative chemotherapy, and exhibited no signs of recurrence in terms of clinical symptoms, tumor markers and imaging findings. In 2007, Her CA 125 was normal range and her clinical symptoms, pelvic examination was unremarkable. but, routine CT scan of pelvic and abdomen showed 3 ) 2.5 cm lobulating contour splenic lesion that was not evident on previous CT scans. Also, PET-CT scan of whole body suggested hypermetabolic lesion at spleen. Measurements and Main Results: After penumococcal vaccination, she underwent laparoscopic splenectomy and microscopy confirmed the splenic tumor to be of the same histologic type as the ovarian cancer. She received six cycles of paclitaxel-carboplatin. At present, she remains disease-free 8 months after the surgery. Conclusion: Solitary splenic metastasis occurs relatively rarely in ovarian cancer. Laparoscopic splenectomy is a proper therapeutic modality for an isolated splenic metastasis form ovarian cancer.
477 A Rare Case of Clear Cell Cystadenofibroma of Ovary Choi JH, Suh MJ, Park DC. OB-Gyn, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Republic of Korea Study Objective: Most clear cell tumors of the ovaries are carcinomas; benign and borderline clear cell tumors are uncommon. We describe here an ovarian clear cell cystadenofibroma that was misdiagnosed before laparoscopic surgery as a borderline malignant cystic mass of the ovary. Patients: A 52-year-old woman presented with a painless palpable mass in her left lower quadrant abdomen. Serum concentrations of the tumor markers CA-125 and CA19-9 were 22.1 ng/mL and 15.0 ng/mL, respectively. Computed tomography showed a cystic tumor, approximately 7.7x6.0x5.9 cm in size, with a distinct border in the left adnexa. A high density area with enhanced contrast was observed in the front area of the tumor, suggesting a borderline malignant ovarian tumor. Measurements and Main Results: The patient underwent laparoscopic surgery, with all procedures performed in an endo-pouch. The tumor was generally round and hard, with papillary growing nodules at the surface. A blue-gray cyst approximately 7 cm in size and with a distinct border was observed in the left ovary. After aspiration of dark brown serous cystic fluid, a gray-brown hard solid area approximately 3x4 cm in size remained. The tumor was removed through the trocar port. Macroscopically, we observed a gray-brown solid mass approximately 3x4 cm in size before destruction of the capsule. The cross-sectioned tumor was pale gray-white in color, with several small cystic structures, giving it a beehive-like appearance. Histologically, we observed a dilated gland surrounded by fibrous matrix consisting of spindle cells, as well as epithelium lined by hobnail cells, squamous cells, and clear cells but no evidence of dysplasia or mitosis. The tumor was ultimately diagnosed as a clear cell cystadenofibroma. Conclusion: Laparoscopic surgery using endo pouch for ovarian tumor is safe and effective even in case of suspicious borderline malignancy.
Study Objective: To determine the proportion of gynecologic oncologists performing robotic surgery and to determine the level of fellows’ training in robotic surgery. Design: Survey administered by mail or internet in 2007. Patients: Full or candidate members of the Society of Gynecologic Oncologists. Measurements and Main Results: Three hundred forty-nine (39%) of SGO members responded. Currently, only 27% utilize the robot in their practice. Reasons for not using the robot included: hospital does not own a robotic system (32%); capable of performing all procedures with traditional laparoscopy (22%); robot limits laparoscopic exposure for trainees (9%). Among robot users, 19% utilize it for more than 75% of their laparoscopic cases while 55% use it for less than 25% of their minimally-invasive surgeries. Thirty-seven percent felt the robot was appropriate for hysterectomy/staging in endometrial cancer, 33% felt it appropriate for radical hysterectomy/pelvic lymphadenectomy, and 15% as a diagnostic instrument for adnexal masses. For procedures that respondents do not perform with traditional laparoscopy, 17% are able to perform laparoscopic radical hysterectomy and 10% perform hysterectomy/staging for endometrial cancer using the robot. Two-thirds of respondents thought their use of the robot would increase in the next year while an additional 15% stated that although they do not currently utilize it, they were planning on beginning. For those respondents who train fellows, 75% allow the fellow to sit at the console although 73% do so in less than half their cases. For those who train residents, only 30% allow them to sit at the console although 79% do so in less than half their cases. Conclusion: Gynecologic oncologists are embracing robotic surgery more quickly than they did traditional laparoscopy especially considering the limits of availability. Most SGO members plan to increase their usage in the next year.
479 The Study of Staging Laparoscopy for Cervical Cancer Funamoto H. Obsterics and Gynecology, Toyama Prefectural Central Hospital, Toyama, Japan Study Objective: To assess the efficacy of staging laparoscopy for cervical cancer. Design: Retrospective analysis of 38cases underwent staging laparoscopy. Setting: Toyama Prefectural Central Hospital. Patients: 38 patients with cervical cancer. Intervention: Laparoscopic para-aortic lymphadenectomy. Measurements and Main Results: From September 1998 to December 2007, thirty-eight patients underwent this procedure for cervical cancer. Preoperative evaluation according to the FIGO guidelines showed 7 patients in stage Ib, 4 in IIa, 16 in IIb, 10 in IIIb and 1 in IVa. Histopathologically, there were 28 cases of squamous carcinoma, 8 cases of adenocarcinoma and 2 cases of adenosquamous cell carcinoma. The mean estimated blood loss was 101 ml and the mean operative time was 129 minutes. The average number of para-aortic lymph nodes removed laparoscopically was 11.4. In one case, bleeding from the left ovarian artery necessitated blood transfusion, and no port site recurrence was observed. Microscopic metastasis of para-aortic lymph nodes was detected in 5 (16.7 %) out of 26 patients with negative findings by preoperative computed tomography, and only two (33.3%) out of the six suspicious cases by preoperative CT were actually positive by staging laparoscopy. Conclusion: Staging laparoscopy for cervical cancer is necessary to determine the surgical staging before main treatment and the range of radiation for any patients who need radiotherapy.
Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159 480 A Comparison of Robotically-Assisted and Open Radical Hysterectomy for Early Stage Cervical Cancer Hoekstra AV, Jairam-Thodla A, Berry E, Lurain JR, Buttin BM, Singh DK, Schink JC, Lowe MP. Obstetrics and Gynecology, Feinberg School of Medicine of Northwestern University, Chicago, Illinois Study Objective: To report a pilot series comparing perioperative outcomes of robotically-assisted radical hysterectomy with traditional open radical hysterectomy for early stage cervical cancer. Design: A prospective analysis of 10 patients undergoing radical hysterectomy for early stage cervical cancer over 6 months. Setting: An academic group practice with a fellowship training program in an urban area. Patients: 10 women with early stage cervical cancer. Intervention: Robotically-assisted radical hysterectomy or traditional open radical hysterectomy with pelvic lymphadenectomy. Measurements and Main Results: Ten patients who underwent radical hysterectomy for cervix cancer were identified in the first 6 months after the introduction of the robotic surgery program. Six patients underwent robotically-assisted (ROB) radical hysterectomy and 4 open (LAP) radical hysterectomy. Median age (40 vs. 42; p 5 0.39) did not differ between groups. BMI (30 vs. 26; p 5 0.084) was higher in the LAP vs. the ROB group, but the difference did not reach statistical significance. Stage (100% vs. 83% stage IB;p 5 0.6) and grade (75% vs. 50% grade 2/ 3;p 5 0.23) distributions did not differ between the LAP and ROB groups, respectively. The ROB group trended towards shorter median operating time (255 min vs. 285 min; p 5 0.39), although it did not reach significance. The ROB group had a highly significant decrease in EBL (75 mL vs. 725 mL; p 5 0.01). Median lymph node counts (22.5 vs. 22.0;p 5 0.67) did not differ between the LAP and ROB groups. Patients in the ROB groups had a significantly shorter median hospital stay (1 vs. 3 days;p 5 0.0034) when compared to the LAP group. The rate of robotic radical hysterectomy increased from 0% to 60% within 6 months of the introduction of the robotic surgery program. Conclusion: The introduction of a robotic surgery program significantly changed practice patterns at one gynecologic oncology fellowship training institution. Lower blood loss and shorter hospital stay were significant advantages of robotic surgery for patients undergoing radical hysterectomy in our pilot series.
481 Successful Laparoscopic Removal of Huge Ovarian Cyst (7,000cc) through Umbilical and Two 5mm Cannula Sites Kim Y-W. Obstetrics and Gynecology, College of Medicine, Catholic University of Korea, Incheon, Republic of Korea Study Objective: Laparoscopic management of huge ovarian tumor is rare and controversial, because of the possibility of malignancy and technical difficulties. We present a patent with huge ovarian cyst (7,000 cc) who underwent successful laparoscopic surgery. We just inserted three cannulas (10 mm umbilical and two 5 mm lower abdominal cannulas). After aspiration of its contents, cystectomy was performed and the cyst was extracted through umbilicus cannula site (15 mm). The postoperative course was uneventful. No intra-operative and post-operative complications were observed. With proper case selection, minimally invasive surgery can be performed safely and effectively in patients with extremely large ovarian cyst.
482 Multidimensional Assessment of the Learning Curve for Laparoscopic Lymphadenectomy in Patients with Gynecologic Malignancies: A Preliminary Report Kim WY,1 Chang SJ,1 Ji YI,2 Yoon JH,1 Yoo SC,1 Chang KH,1 Ryu HS.1 1 Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Gyunggi-do, Republic of Korea; 2Obstetrics and Gynecology, Cheongju St. Mary’s Hospital, Cheongju, Chungcheongbuk-do, Republic of Korea
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Study Objective: To define a multidimensional learning curve for laparoscopic lymphadenectomy in patients with gynecologic malignancies. Design: Prospective analysis of 25 cases of laparoscopic cancer surgery including lymphadenectomy. Setting: University Hospital. Patients: Twenty-five patients with gynecologic malignancies (10 cervical cancer, 13 endometrial cancer, and 2 ovarian cancer). Intervention: Laparoscopic cancer surgery including pelvic and para-aortic lymphadenectomy. Measurements and Main Results: One surgeon, who had completed a 2-year fellowship courses on gynecologic cancer surgery in two university hospitals, performed all procedures. The moving average method was used to demonstrate the change of the operation time for lymphadenectomy. Cumulative sum method was used to analyze the changes in the total number of retrieved lymph nodes, laparotomy conversion, and complications. The operation time decreased from 165.9 minutes to 145.0 minutes after 10 operations. The number of retrieved lymph nodes (O 11) and complications were reached to a steady state after 12 consecutive procedures (90% success rate). There was no laparotomy conversion. Conclusion: The assessment of learning curve should not be limited to measurement of a decrease in operation time, but should also include the optimal oncologic outcome (e.g., lymph node count), complications, and conversion rates. These data might be especially useful for those planning training programs in laparoscopic surgery.
483 Laparoscopic Management of Mu¨llerian Adenosarcoma e A Case Report Koh LW, Wong CN, Huang MH. Obstetrics and Gynecology, Show Chwan Memorial Hospital, Changhua, Taiwan Republic of China Study Objective: To report a case of mullerian adenosarcoma by performing LAVH and bilateral pelvic lymph node sampling. Design: A case report. Setting: Show Chwan Memorial Hospital. Patients: A 28-year-old, unmarried, sexually active, obese (BMI 38.3 kg/ m2) young girl was presented with irregular vaginal spotting noticed for 2 months after amenorrhea for 5 years. Intervention: Gynecologic vaginal speculum examination revealed fleshy with eroded surface, polypoid configuration mass protruded from cervical introitus. Transvaginal sonography denote increase in uterine size with heterogeneously thickened endometrium.Biopsy of the polypoid mass was performed at other medical center with histologic report of low grade Adenosarcoma. Laparoscopic surgical staging (LAVH, bilateral salpingoophorectomies, pelvic lymph node sampling and washing cytology) was planned on the basic of clinical assessment and preliminary histologic report. Measurements and Main Results: Total Operative time was 150 minutes and the volume of blood loss intraoperatively was 200 ml. Patient was discharge on fourth postoperative days. Macroscopically, the polypoid mass was arose from uterine fundus with intravaginal extension and the extension was limited to endometrium. Final histologic showed low grade adenosarcoma with negative lymph node and no myometrial invasion. Conclusion: A best approach for management of uterine adenosarcoma was yet to be defined; surgery, chemotherapy, radiotherapy and follow-up have all been elucidated. In our case, surgery with follow-up seem to be an appropriate course of action due to the early stage of this rare cancer.
484 Cardiac Migration of a Fractured Infusaport Catheter Treated with Anticoagulation Kotikela S, Malviya VK. OB-GYN, Providence Hospital, Southfeild, Michigan Study Objective: Dislodgement of mediport catheter is a rare but recognised complication of indwelling vascular catheters. We present a patient with nonretreivable fractured catheter which was firmly adherent