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Comprehensive Staging of Uterine Carcinosarcoma Using a Multiquadrant Robotic Platform
Accepted Manuscript Comprehensive staging of uterine carcinosarcoma utilizing a multiquadrant robotic platform Thanh H. Dellinger, MD, Mark T. Wakabayashi, MD, Ernest S. Han, MD PII:
S1553-4650(16)31152-9
DOI:
10.1016/j.jmig.2016.10.010
Reference:
JMIG 2977
To appear in:
The Journal of Minimally Invasive Gynecology
Received Date: 8 September 2016 Revised Date:
30 September 2016
Accepted Date: 19 October 2016
Please cite this article as: Dellinger TH, Wakabayashi MT, Han ES, Comprehensive staging of uterine carcinosarcoma utilizing a multiquadrant robotic platform, The Journal of Minimally Invasive Gynecology (2016), doi: 10.1016/j.jmig.2016.10.010. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
1
Comprehensive staging of uterine carcinosarcoma utilizing a multiquadrant robotic platform
2
Thanh H. Dellinger, MD, Mark T. Wakabayashi, MD, Ernest S. Han, MD
4
Department of Surgery, Division of Gynecologic Oncology
5
City of Hope National Medical Center, Duarte, CA
6
U.S.A
SC M AN U
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16
TE D
Thanh H. Dellinger, MD, Assistant Professor Division of Gynecologic Oncology ♦ Department of Surgery City of Hope National Medical Center 1500 E. Duarte Road, Machris 1128, Duarte, CA 91010 U.S.A. Tel: (626) 256-4673 x63505 ♦ Fax: (626) 471-7155 ♦ Cell: 626-384-6287
EP
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Corresponding author:
AC C
8
RI PT
3
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Keywords: Multi-quadrant robotic staging, uterine carcinosarcoma, infrarenal para-aortic
18
lymphadenectomy, infragastric omentectomy
19
20
Conflict of Interest Statement:
21
The authors declare that there are no conflicts of interest.
ACCEPTED MANUSCRIPT
ABSTRACT
23
OBJECTIVE: To demonstrate the feasibility of multi-quadrant staging of a uterine
24
carcinosarcoma using the latest-generation robotic platform.
25
DESIGN: Step-by-step explanation of the technique using videos and pictures (educative video).
26
SETTING: While laparoscopic and robotic-assisted laparoscopic staging of high-risk uterine
27
cancer is well incorporated into many gynecologic oncology practices, extensive para-aortic
28
lymphadenectomies above the inferior mesenteric artery are less commonly performed.
29
Additionally, infracolic omentectomies are frequently performed in lieu of infragastric
30
omentectomies. We demonstrate in this video a facile approach for robotic surgeons to
31
perform an extensive para-aortic lymphadenectomy up to the renal vessels, as well an
32
infragastric omentectomy, utilizing the latest-generation multi-quadrant robotic platform. This
33
platform allows for facile rotation from an upper abdominal view to perform the para-aortic
34
lymphadenectomy and omentectomy, to a pelvic view to complete the pelvic
35
lymphadenectomies and hysterectomy/BSO. We demonstrate this technique in a 67-year old
36
female with a newly diagnosed uterine carcinosarcoma, who underwent a robotic-assisted
37
laparoscopic total hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic and para-
38
aortic lymphadenectomy and infragastric omentectomy via the Xi Da Vinci Robot. Total
39
operative time was 280 minutes (50 minutes for the omentectomy, 86 minutes for the para-
40
aortic lymphadenectomy). Estimated blood loss was 50 mL. Final pathology revealed a Stage IA
41
uterine carcinosarcoma; a total of 27 para-aortic lymph nodes and 20 pelvic lymph nodes were
42
removed; the size of the excised omentum was 68 x 10 x 1.2 cm.
AC C
EP
TE D
M AN U
SC
RI PT
22
ACCEPTED MANUSCRIPT
INTERVENTIONS: Multiquadrant comprehensive staging of uterine carcinosarcoma utilizing the
44
latest-generation robotic platform.
45
CONCLUSION: The technique of utilizing alternating dual perspectives (upper abdominal or
46
pelvic views) through a multiquadrant robotic platform enables the robotic surgeon to perform
47
extensive para-aortic lymphadenectomies and omentectomies without resorting to
48
laparoscopic surgery to complete these procedures.
SC M AN U
49
EP
TE D
Human Subjects approval was exempt for the above research.
AC C
50
RI PT
43
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
S1553-4650(16)31152-9
DOI:
10.1016/j.jmig.2016.10.010
Reference:
JMIG 2977
To appear in:
The Journal of Minimally Invasive Gynecology
Received Date: 8 September 2016 Revised Date:
30 September 2016
Accepted Date: 19 October 2016
Please cite this article as: Dellinger TH, Wakabayashi MT, Han ES, Comprehensive staging of uterine carcinosarcoma utilizing a multiquadrant robotic platform, The Journal of Minimally Invasive Gynecology (2016), doi: 10.1016/j.jmig.2016.10.010. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
1
Comprehensive staging of uterine carcinosarcoma utilizing a multiquadrant robotic platform
2
Thanh H. Dellinger, MD, Mark T. Wakabayashi, MD, Ernest S. Han, MD
4
Department of Surgery, Division of Gynecologic Oncology
5
City of Hope National Medical Center, Duarte, CA
6
U.S.A
SC M AN U
7
16
TE D
Thanh H. Dellinger, MD, Assistant Professor Division of Gynecologic Oncology ♦ Department of Surgery City of Hope National Medical Center 1500 E. Duarte Road, Machris 1128, Duarte, CA 91010 U.S.A. Tel: (626) 256-4673 x63505 ♦ Fax: (626) 471-7155 ♦ Cell: 626-384-6287
EP
9 10 11 12 13 14 15
Corresponding author:
AC C
8
RI PT
3
17
Keywords: Multi-quadrant robotic staging, uterine carcinosarcoma, infrarenal para-aortic
18
lymphadenectomy, infragastric omentectomy
19
20
Conflict of Interest Statement:
21
The authors declare that there are no conflicts of interest.
ACCEPTED MANUSCRIPT
ABSTRACT
23
OBJECTIVE: To demonstrate the feasibility of multi-quadrant staging of a uterine
24
carcinosarcoma using the latest-generation robotic platform.
25
DESIGN: Step-by-step explanation of the technique using videos and pictures (educative video).
26
SETTING: While laparoscopic and robotic-assisted laparoscopic staging of high-risk uterine
27
cancer is well incorporated into many gynecologic oncology practices, extensive para-aortic
28
lymphadenectomies above the inferior mesenteric artery are less commonly performed.
29
Additionally, infracolic omentectomies are frequently performed in lieu of infragastric
30
omentectomies. We demonstrate in this video a facile approach for robotic surgeons to
31
perform an extensive para-aortic lymphadenectomy up to the renal vessels, as well an
32
infragastric omentectomy, utilizing the latest-generation multi-quadrant robotic platform. This
33
platform allows for facile rotation from an upper abdominal view to perform the para-aortic
34
lymphadenectomy and omentectomy, to a pelvic view to complete the pelvic
35
lymphadenectomies and hysterectomy/BSO. We demonstrate this technique in a 67-year old
36
female with a newly diagnosed uterine carcinosarcoma, who underwent a robotic-assisted
37
laparoscopic total hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic and para-
38
aortic lymphadenectomy and infragastric omentectomy via the Xi Da Vinci Robot. Total
39
operative time was 280 minutes (50 minutes for the omentectomy, 86 minutes for the para-
40
aortic lymphadenectomy). Estimated blood loss was 50 mL. Final pathology revealed a Stage IA
41
uterine carcinosarcoma; a total of 27 para-aortic lymph nodes and 20 pelvic lymph nodes were
42
removed; the size of the excised omentum was 68 x 10 x 1.2 cm.
AC C
EP
TE D
M AN U
SC
RI PT
22
ACCEPTED MANUSCRIPT
INTERVENTIONS: Multiquadrant comprehensive staging of uterine carcinosarcoma utilizing the
44
latest-generation robotic platform.
45
CONCLUSION: The technique of utilizing alternating dual perspectives (upper abdominal or
46
pelvic views) through a multiquadrant robotic platform enables the robotic surgeon to perform
47
extensive para-aortic lymphadenectomies and omentectomies without resorting to
48
laparoscopic surgery to complete these procedures.
SC M AN U
49
EP
TE D
Human Subjects approval was exempt for the above research.
AC C
50
RI PT
43
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT