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Laparoendoscopic Single-site Radical Hysterectomy: Sufficient Exposure via Effective Suspension
Laparoendoscopic Single-site Radical Hysterectomy: Sufficient Exposure via Effective Suspension Sijing Chen, MM, Xiaorong Qi, MD, Lin Chen, MM, Fenqin Li, MM, Na Wang, MM, Yawen Wang, MM, and Ying Zheng, MD From the Department of Gynecologic Oncology, West China Second Hospital, Sichuan University (all authors), and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China (all authors).
ABSTRACT Study Objective: To perform a radical hysterectomy for early-stage cervical cancer through laparoendoscopic single-site (LESS) approach and demonstrate if the effective suspension could achieve different exposed purposes and space extension. Design: Presentation of the surgery through this technical video. Setting: Hospital. Interventions: A 52-year-old menopausal woman who presented with postcoital bleeding for 3 months was diagnosed with poorly differentiated (G3) cervical squamous cell carcinoma with International Federation of Gynecology and Obstetrics stage IB1. The patient was carefully consulted about the oncologic risks of the different surgical approaches; thereafter, the LESS approach was decided with informed consent. The LESS procedures for staging surgery were completed. The estimated blood loss was 60 mL, and operation time was 250 minutes. Results of the pathology report showed G3 squamous cell carcinoma and no pelvic lymph nodes metastases. The Foley catheter was removed on the 21st day, and the bladder function recovered completely after removal. She was followed up for a year without any evidence of recurrence or complications. Conclusion: Because of technical difficulties with a limited number of hands, complex surgeries, such as radical hysterectomy, have rarely been performed using the LESS approach [1]. The dissection of vesicocervical and parametrial space is critical to radical hysterectomy, and inadequate exposure to these spaces during the procedure presents major difficulties [2]. In the video, surgery for cervical cancer was performed successfully and met the International Federation of Gynecology and Obstetrics’ standards for type C radical hysterectomy. Our video demonstrated that the varied and flexible suspension played a significant role in providing clear vision and sufficient exposure; furthermore, it was feasible, effective, and safe in the LESS approach [3,4]. Journal of Minimally Invasive Gynecology (2019) 00, 1−2. © 2019 AAGL. All rights reserved. Keywords:
Laparoendoscopic single-site; Suspended techniques; Radical hysterectomy
The authors declare that they have no conflict of interest. This work was supported by Key Research and Development Projects of Sichuan Science and Technology Department Fund (2017SZ0064). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards, and this manuscript received approval by the institutional review board. 1553-4650/$ — see front matter © 2019 AAGL. All rights reserved. https://doi.org/10.1016/j.jmig.2019.08.030
Corresponding author: Ying Zheng, MD, Department of Gynecologic Oncology, West China Second Hospital, Sichuan University, No. 17, Renmin South Rd, Chengdu, Sichuan 610041, People’s Republic of China. E-mail: [email protected] Submitted June 3, 2019, Revised July 30, 2019, Accepted for publication August 30, 2019. Available at www.sciencedirect.com and www.jmig.org
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Journal of Minimally Invasive Gynecology. Vol 00, No 00, 00 2019
References 1. Moukarzel LA, Fader AN, Tanner EJ. Feasibility of robotic-assisted laparoendoscopic single-site surgery in the gynecologic oncology setting. J Minim Invasive Gynecol. 2017;24:258–263. 2. Park JY, Kim YM, Lee YY, et al. Laparoendoscopic single-site radical hysterectomy for early stage cervical cancer. Obstet Gynecol Sci. 2017;60:110–114. 3. Boruta DM, Fagotti A, Bradford LS, et al. Laparoendoscopic single-site radical hysterectomy with pelvic lymphadenectomy: initial multi-institutional experience for treatment of invasive cervical cancer. J Minim Invasive Gynecol. 2014;21:394–398. 4. Desai R, Puntambekar SP, Lawande A, et al. More with LESS: a novel report of nerve sparing radical hysterectomy performed using LESS. J Minim Invasive Gynecol. 2013;20:886–890.
Supplementary materials Supplementary material associated with this article can be found in the online version at https://doi.org/10.1016/j. jmig.2019.08.030.
ABSTRACT Study Objective: To perform a radical hysterectomy for early-stage cervical cancer through laparoendoscopic single-site (LESS) approach and demonstrate if the effective suspension could achieve different exposed purposes and space extension. Design: Presentation of the surgery through this technical video. Setting: Hospital. Interventions: A 52-year-old menopausal woman who presented with postcoital bleeding for 3 months was diagnosed with poorly differentiated (G3) cervical squamous cell carcinoma with International Federation of Gynecology and Obstetrics stage IB1. The patient was carefully consulted about the oncologic risks of the different surgical approaches; thereafter, the LESS approach was decided with informed consent. The LESS procedures for staging surgery were completed. The estimated blood loss was 60 mL, and operation time was 250 minutes. Results of the pathology report showed G3 squamous cell carcinoma and no pelvic lymph nodes metastases. The Foley catheter was removed on the 21st day, and the bladder function recovered completely after removal. She was followed up for a year without any evidence of recurrence or complications. Conclusion: Because of technical difficulties with a limited number of hands, complex surgeries, such as radical hysterectomy, have rarely been performed using the LESS approach [1]. The dissection of vesicocervical and parametrial space is critical to radical hysterectomy, and inadequate exposure to these spaces during the procedure presents major difficulties [2]. In the video, surgery for cervical cancer was performed successfully and met the International Federation of Gynecology and Obstetrics’ standards for type C radical hysterectomy. Our video demonstrated that the varied and flexible suspension played a significant role in providing clear vision and sufficient exposure; furthermore, it was feasible, effective, and safe in the LESS approach [3,4]. Journal of Minimally Invasive Gynecology (2019) 00, 1−2. © 2019 AAGL. All rights reserved. Keywords:
Laparoendoscopic single-site; Suspended techniques; Radical hysterectomy
The authors declare that they have no conflict of interest. This work was supported by Key Research and Development Projects of Sichuan Science and Technology Department Fund (2017SZ0064). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards, and this manuscript received approval by the institutional review board. 1553-4650/$ — see front matter © 2019 AAGL. All rights reserved. https://doi.org/10.1016/j.jmig.2019.08.030
Corresponding author: Ying Zheng, MD, Department of Gynecologic Oncology, West China Second Hospital, Sichuan University, No. 17, Renmin South Rd, Chengdu, Sichuan 610041, People’s Republic of China. E-mail: [email protected] Submitted June 3, 2019, Revised July 30, 2019, Accepted for publication August 30, 2019. Available at www.sciencedirect.com and www.jmig.org
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Journal of Minimally Invasive Gynecology. Vol 00, No 00, 00 2019
References 1. Moukarzel LA, Fader AN, Tanner EJ. Feasibility of robotic-assisted laparoendoscopic single-site surgery in the gynecologic oncology setting. J Minim Invasive Gynecol. 2017;24:258–263. 2. Park JY, Kim YM, Lee YY, et al. Laparoendoscopic single-site radical hysterectomy for early stage cervical cancer. Obstet Gynecol Sci. 2017;60:110–114. 3. Boruta DM, Fagotti A, Bradford LS, et al. Laparoendoscopic single-site radical hysterectomy with pelvic lymphadenectomy: initial multi-institutional experience for treatment of invasive cervical cancer. J Minim Invasive Gynecol. 2014;21:394–398. 4. Desai R, Puntambekar SP, Lawande A, et al. More with LESS: a novel report of nerve sparing radical hysterectomy performed using LESS. J Minim Invasive Gynecol. 2013;20:886–890.
Supplementary materials Supplementary material associated with this article can be found in the online version at https://doi.org/10.1016/j. jmig.2019.08.030.