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Oral Presentations SATURDAY, NOVEMBER 12, 2005 (2:33 PM–2:39 PM) Open Communications 11—Operative Endoscopy 207 Total Laparoscopic Radical Hysterectomy for Invasive Cervical Cancer: Initial Reports Lee YS, Lee H, Park C. Taegu, Korea; Daegu, Korea; Daegu, Korea Study Objective: The purposes of this study were to evaluate the surgical outcomes and to discuss the role of completely total laparoscopic radical hysterectomy in the cervical cancer. To the best of our knowledge, this is the first study of completely total laparoscopic radical hysterectomy. Design: Prospective analysis. Setting: University hospital. Patients: Among the 32 patients, Twenty-two patients who underwent completely total laparoscopic radical hysterectomy between November 2003 and Feb. 2005 were studied prospectively. Among them, 17 patients had completely total laparoscopic radical hysterectomy but five patients underwent vaginal incision and suturing through vagina. Intervention: Completely total laparoscopic radical hysterectomy for invasive cervical cancer. Measurements and Main Results: Type 3 radical hysterectomy was done in 16 cases and one had type 2. Conversion to laparotomy was not required in any case. Mean operative time was 192 ⫹/⫺48 minutes and mean blood loss was 226 ⫹/⫺193 mL. There were one bladder injury in intraoperative, and there were one ileus in postoperative period. And no vaginal wound disruption or infection. Mean postoperative hospital stay were 7.8 ⫹/- 2.2 days. Mean self voiding day was 8.8 ⫹/- 4.6 days. All resected margins were tumor free. The mean number of retrieved pelvic lymph nodes were 26 ⫹/- 12 (range 8 to 50). Three patients had postoperative radiotherapy. Conclusion: This prospective trial demonstrated that total laparoscopic radical hysterectomy had good results and were feasible and safe procedures. In addition, we concluded that the completely total laparoscopic radical hysterectomy for invasive cervical cancer can obtain adequate margins and follow oncologic principles. SATURDAY, NOVEMBER 12, 2005 (2:39 PM–2:45 PM) Open Communications 11—Operative Endoscopy 208 A Retrospective Review of Selected LaparoscopicAssisted Radical Parametrectomy for Incidental Cancer after a Simple Hysterectomy: Ten Years’ Experience Tang W, Liu W, Wang I. Taipei Medical University Hospital, Taipei, Taiwan Study Objective: To review the outcome of selective laparoscopic-assisted radical parametrectomy performed for in-
S85 cidental cervical cancer following a simple hysterectomy in patient with benign pelvic disease. Design: Prospective review. Setting: University-affiliated tertiary referral center. Patients: We collected 13 patients undergoing hysterectomy who were found to have incidental early stage cervical cancer. At the same time, negative surgical margins and no gross tumor were found at initial hysterectomy specimen. Intervention: Lat first, retrieval of pelvic lymph nodes were performed by using laparoscope. Then, exploratory laparotomy was performed along previous operative wound or a 12cm vertical incision. We used two Allis holding the vaginal cuff as a guide for parametrectomy and upper vaginectomy. Measurements and Main Results: The mean age of these patients was 44.62 ⫾ 1.40 years (range 36 to 55). The selective laparoscopic-assisted parametrectomy was performed on average 4.23 ⫾ 0.32 weeks after a simple hysterectomy (range 2 to 6). Laparoscopic retrieval of pelvic lymph nodes was failed in one case for severe adhesion. The mean number of laparoscopic retrieval of pelvic lymph nodes was 41.09 ⫾ 1.31 (37–52). The successful rate of this kind of operation was 92.3%. Operative pathologic findings of radical specimens indicated no evidence of residual lesions in 92% (12/13) patients. No patients had a recurrence within a median follow-up 59.67 ⫾ 7.24 months (12–106). The mean blood loss was 352.72 ⫾ 21.91 cc (250 to 500). The average of admission was shortened 2.7 days than primary radical hysterectomy. Conclusion: Laparoscopic-assisted parametrectomy was an acceptable option for patient with incidental early stage of cervical cancer after a simple hysterectomy and produces low morbidity with excellent cure rate. SATURDAY, NOVEMBER 12, 2005 (2:45 PM–2:51 PM) Open Communications 11—Operative Endoscopy 209 Video Laparoscopic-Assisted Cytoreduction in Advanced Ovarian Cancer: Farghaly’s Technique Farghaly SA. The Weill Medical College and the New York Presbyterian Hospital-Cornell University Medical Center, Cornell University, New York, New York Study Objective: To evaluate the laparoscopic approach to cytoreduction surgery in advanced ovarian cancer. Design: Patients with advanced ovarian cancer undergoing surgical staging and cytoreduction. Setting: Inpatient. Patients: Primary trocars established below the umblicus and, a 12 mm blunt trocar is introduced. Four secondary sites are established: subumbilical, left lower quadrant, right lower quadrant, and above the pubic hair line lateral to deep epigastric vessels. A 12 mm operating laparoscope with 7.5 mm operational channel is used to perform this technique. Peritoneal and retroperitoneal structures are thoroughly vi-
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Journal of Minimally Invasive Gynecology, Vol 12, No 5, September/October Supplement 2005
sualized. Patients are undergone surgical and debulking. Trocars are closed with surgical clips. Intervention: Harmonic Scalpel (HS) is used for cutting and coagulation of the affected areas on the peritoneum, and retroperitoneum surfaces. The advantages of using the Harmonic Scalpel are: it reduces blood loss, it reduces the length of surgery, it produces less vision obscuring smoke and in doing so it facilitates the performance of this video assisted technique, and it minimizes the damage of healthy tissues. Measurements and Main Results: Operative time can be maintained in 3 hours, and hospital stay for 2 days. Conclusion: Farghaly’s technique of video laparoscopic assisted cytoreduction is safe and feasible. This technique allows for through evaluation of the peritoneal and retroperitoneal structures, and surgical cytoreduction while retaining the advantages of minimally invasive surgery.
of the benefits of both routes in the same patient. Stage I endometrial, microinvasive cervical and early ovarian cancers may be treated with a combination of a laparoscopic staging procedure and vaginal or laparoscopic simple hysterectomy and vaginal surgery may follow laparoscopic staging in the same session. Laparoscopic lymphadenectomy is used in diagnostics for staging of malignancy but also for therapy of malignant disease. It has the same role in treatment of disease as conventional lymphadenectomy in open abdominal surgery. Laparoscopic lymphadenectomy in radical hysterectomy is acceptable only if it strictly mimics open abdominal surgery. Combination of LPSC lymphadenectomy with radical vaginal surgery (Shauta - Steckel) is today the most acceptable procedure in our opinion.
SATURDAY, NOVEMBER 12, 2005 (2:51 PM–2:57 PM)
SATURDAY, NOVEMBER 12, 2005 (2:57 PM–3:03 PM)
Open Communications 11—Operative Endoscopy
Open Communications 11—Operative Endoscopy
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211
Pelvic (Intraperitoneal) and Paraaortic (Extraperitoneal) Laparoscopic Lymphadenectomy in Gynecological Myomas Kopjar M, Zadro M, Maricic I, Scuric I. Croatian Society for Gynaecological Endoscopy of CMA, Zagreb, Croatia; Zagreb, Croatia; Zagreb, Croatia; Sv. Kriz Zacretje, Croatia
New Hysteroscopic Resection Technique to Obtain Adequate Sampling for Histological Evaluation in Preneoplastic and Neoplastic Lesions of the Cervix Zeloni R, Votano S, Vittori G, Bassani A, Rahimi S, Lena A, Camilli F. Rome, Italy
Study Objective: To compare efficacy and safety of classical and laparoscopic radical operations in case of gynecological myomas. Design: Retrospective analysis of 38 classical radical operations and 14 laparoscopic radical operations. Setting: Obstetric and gynecological department in county hospital. Patients: Fifty-two women with gynecological myomas-30 endometrium, 7 cervix and 15 ovary. Intervention: Classic and laparoscopic radical operations were performed. Measurements and Main Results: With classical approach we removed average of 9.2 pelvic and 7.1 paraaortic lymph nodes compared with 8.3 pelvic and 5.3 paraaortic nodes removed laparoscopically. Average blood loss was similar (420 vs. 410 ml); also the hospital stay (7 days) but laparoscopic operations were longer (380 vs. 310 minutes). We had total of 10.5% complications with classical approach and 7.1% complications in laparoscopic approach. Conclusion: The introduction of laparoscopic surgery in gynecological oncology had two consequences: a revival of radical vaginal hysterectomy and encouraged development of laparoscopic radical hysterectomy with pelvic and paraaortic laparoscopic lymphadenectomy. The rational of laparoscopic - vaginal modified radical vaginal hysterectomy is that an oncologic surgeon is able to take advantage
Study Objective: To assess safety of hysteroscopic endocervical resection (HECR) in the evaluation of preneoplastic and neoplastic lesions of the cervix and its efficacy providing histologic specimens more adequate than endocervical curettage (ECC). Design: Analysis of endocervical specimens collected by 35 consecutive hysteroscopic resections. Setting: Obstetrics and gynecology teaching hospital. Patients: Thirty-four patients (ages 29 – 69) with squamous and/or glandular cervical lesions and the indication to undergo ECC. Intervention: Hysteroscopic resection of endocervical tissue (epithelium and underlying stroma) was performed right after LEEP in 30 out of 34 cases. Measurements and Main Results: In each patient 1 to 5 chips were collected (mean quantity: 3.15) according to age, parity and clinical features (overall n° 112 specimens). Chips length ranged 0.6 to 5 cm with mean width of 0.4 cm. Only 1/112 chips couldn’t be examined by the pathologist because of thermal damage. In contrast with ECC, all chips could be oriented, were not fragmented and had sufficient stroma. For any specimens we used to specify the siege of the sampling. Conclusion: HECR is a safe and effective procedure, and if preliminary results will be acknowledged, it could be considered an alternative tool to ECC in the management of preneoplastic and neoplastic lesions of the cervix.
S85 cidental cervical cancer following a simple hysterectomy in patient with benign pelvic disease. Design: Prospective review. Setting: University-affiliated tertiary referral center. Patients: We collected 13 patients undergoing hysterectomy who were found to have incidental early stage cervical cancer. At the same time, negative surgical margins and no gross tumor were found at initial hysterectomy specimen. Intervention: Lat first, retrieval of pelvic lymph nodes were performed by using laparoscope. Then, exploratory laparotomy was performed along previous operative wound or a 12cm vertical incision. We used two Allis holding the vaginal cuff as a guide for parametrectomy and upper vaginectomy. Measurements and Main Results: The mean age of these patients was 44.62 ⫾ 1.40 years (range 36 to 55). The selective laparoscopic-assisted parametrectomy was performed on average 4.23 ⫾ 0.32 weeks after a simple hysterectomy (range 2 to 6). Laparoscopic retrieval of pelvic lymph nodes was failed in one case for severe adhesion. The mean number of laparoscopic retrieval of pelvic lymph nodes was 41.09 ⫾ 1.31 (37–52). The successful rate of this kind of operation was 92.3%. Operative pathologic findings of radical specimens indicated no evidence of residual lesions in 92% (12/13) patients. No patients had a recurrence within a median follow-up 59.67 ⫾ 7.24 months (12–106). The mean blood loss was 352.72 ⫾ 21.91 cc (250 to 500). The average of admission was shortened 2.7 days than primary radical hysterectomy. Conclusion: Laparoscopic-assisted parametrectomy was an acceptable option for patient with incidental early stage of cervical cancer after a simple hysterectomy and produces low morbidity with excellent cure rate. SATURDAY, NOVEMBER 12, 2005 (2:45 PM–2:51 PM) Open Communications 11—Operative Endoscopy 209 Video Laparoscopic-Assisted Cytoreduction in Advanced Ovarian Cancer: Farghaly’s Technique Farghaly SA. The Weill Medical College and the New York Presbyterian Hospital-Cornell University Medical Center, Cornell University, New York, New York Study Objective: To evaluate the laparoscopic approach to cytoreduction surgery in advanced ovarian cancer. Design: Patients with advanced ovarian cancer undergoing surgical staging and cytoreduction. Setting: Inpatient. Patients: Primary trocars established below the umblicus and, a 12 mm blunt trocar is introduced. Four secondary sites are established: subumbilical, left lower quadrant, right lower quadrant, and above the pubic hair line lateral to deep epigastric vessels. A 12 mm operating laparoscope with 7.5 mm operational channel is used to perform this technique. Peritoneal and retroperitoneal structures are thoroughly vi-
S86
Journal of Minimally Invasive Gynecology, Vol 12, No 5, September/October Supplement 2005
sualized. Patients are undergone surgical and debulking. Trocars are closed with surgical clips. Intervention: Harmonic Scalpel (HS) is used for cutting and coagulation of the affected areas on the peritoneum, and retroperitoneum surfaces. The advantages of using the Harmonic Scalpel are: it reduces blood loss, it reduces the length of surgery, it produces less vision obscuring smoke and in doing so it facilitates the performance of this video assisted technique, and it minimizes the damage of healthy tissues. Measurements and Main Results: Operative time can be maintained in 3 hours, and hospital stay for 2 days. Conclusion: Farghaly’s technique of video laparoscopic assisted cytoreduction is safe and feasible. This technique allows for through evaluation of the peritoneal and retroperitoneal structures, and surgical cytoreduction while retaining the advantages of minimally invasive surgery.
of the benefits of both routes in the same patient. Stage I endometrial, microinvasive cervical and early ovarian cancers may be treated with a combination of a laparoscopic staging procedure and vaginal or laparoscopic simple hysterectomy and vaginal surgery may follow laparoscopic staging in the same session. Laparoscopic lymphadenectomy is used in diagnostics for staging of malignancy but also for therapy of malignant disease. It has the same role in treatment of disease as conventional lymphadenectomy in open abdominal surgery. Laparoscopic lymphadenectomy in radical hysterectomy is acceptable only if it strictly mimics open abdominal surgery. Combination of LPSC lymphadenectomy with radical vaginal surgery (Shauta - Steckel) is today the most acceptable procedure in our opinion.
SATURDAY, NOVEMBER 12, 2005 (2:51 PM–2:57 PM)
SATURDAY, NOVEMBER 12, 2005 (2:57 PM–3:03 PM)
Open Communications 11—Operative Endoscopy
Open Communications 11—Operative Endoscopy
210
211
Pelvic (Intraperitoneal) and Paraaortic (Extraperitoneal) Laparoscopic Lymphadenectomy in Gynecological Myomas Kopjar M, Zadro M, Maricic I, Scuric I. Croatian Society for Gynaecological Endoscopy of CMA, Zagreb, Croatia; Zagreb, Croatia; Zagreb, Croatia; Sv. Kriz Zacretje, Croatia
New Hysteroscopic Resection Technique to Obtain Adequate Sampling for Histological Evaluation in Preneoplastic and Neoplastic Lesions of the Cervix Zeloni R, Votano S, Vittori G, Bassani A, Rahimi S, Lena A, Camilli F. Rome, Italy
Study Objective: To compare efficacy and safety of classical and laparoscopic radical operations in case of gynecological myomas. Design: Retrospective analysis of 38 classical radical operations and 14 laparoscopic radical operations. Setting: Obstetric and gynecological department in county hospital. Patients: Fifty-two women with gynecological myomas-30 endometrium, 7 cervix and 15 ovary. Intervention: Classic and laparoscopic radical operations were performed. Measurements and Main Results: With classical approach we removed average of 9.2 pelvic and 7.1 paraaortic lymph nodes compared with 8.3 pelvic and 5.3 paraaortic nodes removed laparoscopically. Average blood loss was similar (420 vs. 410 ml); also the hospital stay (7 days) but laparoscopic operations were longer (380 vs. 310 minutes). We had total of 10.5% complications with classical approach and 7.1% complications in laparoscopic approach. Conclusion: The introduction of laparoscopic surgery in gynecological oncology had two consequences: a revival of radical vaginal hysterectomy and encouraged development of laparoscopic radical hysterectomy with pelvic and paraaortic laparoscopic lymphadenectomy. The rational of laparoscopic - vaginal modified radical vaginal hysterectomy is that an oncologic surgeon is able to take advantage
Study Objective: To assess safety of hysteroscopic endocervical resection (HECR) in the evaluation of preneoplastic and neoplastic lesions of the cervix and its efficacy providing histologic specimens more adequate than endocervical curettage (ECC). Design: Analysis of endocervical specimens collected by 35 consecutive hysteroscopic resections. Setting: Obstetrics and gynecology teaching hospital. Patients: Thirty-four patients (ages 29 – 69) with squamous and/or glandular cervical lesions and the indication to undergo ECC. Intervention: Hysteroscopic resection of endocervical tissue (epithelium and underlying stroma) was performed right after LEEP in 30 out of 34 cases. Measurements and Main Results: In each patient 1 to 5 chips were collected (mean quantity: 3.15) according to age, parity and clinical features (overall n° 112 specimens). Chips length ranged 0.6 to 5 cm with mean width of 0.4 cm. Only 1/112 chips couldn’t be examined by the pathologist because of thermal damage. In contrast with ECC, all chips could be oriented, were not fragmented and had sufficient stroma. For any specimens we used to specify the siege of the sampling. Conclusion: HECR is a safe and effective procedure, and if preliminary results will be acknowledged, it could be considered an alternative tool to ECC in the management of preneoplastic and neoplastic lesions of the cervix.