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Laparoscopic omentectomy in staging and treating gynecologic cancers
Selected Scientific Abstracts
Laparoscopic Approach to the Space of Retzius
to patient satisfaction. Therefore, we have also started to perform certain operative techniques at the same time as the diagnostic procedure, with a small-diameter rigid hysteroscope (4.5 mm with operative sheath). At this time, cervical polyps of any dimensions, polyps and pedunculated myomas smaller than 1.5 cm, pedunculated polyps with bases larger than 1.5 cm, and uterine septae are treated with scissors and forceps on an outpatient basis. The innervation of the uterus is such that the procedures cause no pain if they are performed on the endometrium. In fact, pain is associated only with manipulation and stretching of the myometrium. The future of this new approach depends on the design of new instruments with which it will be possible to perform more complex operations without anesthesia.
S Bhoughizane, A Wattiez, M Canis, F Alexandre, C Pomel, JL Pouly, G Mage, MA Bruhat. Polyclinique de I'Hotel Dieu, Universite de Clermont-Ferrand I, Clermont-Ferrand, France.
The Actual Role of Contact Hysteroscopy
Endoscopic techniques allow us to understand better the anatomy of the space of Retzius. All techniques thus far described are blind or semiblind. For the first time, laparoscopy allows the placement of a suture or staple to be precise and confirmed. With knowledge and recognition of the anatomy, this technique does not simply accomplish what older ones did, but does it better. Our study describes the anatomy of the prevesical space of Retzius, identifies the structure, and points out some anatomic landmarks that ensure the success of this technique.
S Bettocchi, G Loverro, N Pansini, L Selvaggi. Department of Gynecology and Obstetrics "R," University of Bari, Bari, Italy.
Laparoscopic Omentectomy in Staging and Treating Gynecologic Cancers GM Boike, JE Graham Jr. Hurley Medical Center, Flint, MI.
The role of contact hysteroscopy is totally different from that described by Baggish in 1979, because new instruments vary the degree of magnification from panoramic vision to 80x. Whereas in the past contact hysteroscopy was an economical, although less efficacious, alternative to hysteroscopy with distention of the uterine cavity, now it is an effective alternative to traditional panoramic hysteroscopy. In 1986 a new procedure, hysteroscopic dating of the endometrium, was introduced in which it was possible to stage the exact phase of the cycle by positioning the hysteroscope on the endometrial surface and visualizing the vascular pattern up to 80x magnification. With the experience gained with this procedure, it was noticed that, besides the physiologic patterns, other abnormal dysfunctional patterns were present that were classified as pseudofunctional dysvascular endometrium (PFDE). It was initially hard to interpret these patterns until a possible correlation was observed between PFDE and dysfunctional uterine bleeding on the one hand, and PFDE and hidden forms of endometrial hyperplasia on the other. Due to the ability to visualize the endometrial surface with wide magnification, contact hysteroscopy is now helpful in establishing the diagnosis of benign uterine pathologies (polyps, myomas) as well as endometrial hyperplasia.
Infracolic omentectomy is an integral part of staging ovarian cancer and a therapeutic maneuver in advanced ovarian pelvic and aortic lymph node sampling. Laparoscopic infracolic omentectomy in the staging of gynecologic cancers is both feasible and safe. From October 1992 through January 1995, 15 laparoscopic omentectomies were performed on our gynecologic oncology service in women whose ages ranged from 25 to 74 years. Thirteen were performed as part of staging ovarian cancer, one for tubal cancer, and one for stage IV endometrial cancer with gross tumor metastases. Eleven patients also underwent laparoscopic retroperitoneal lymph node sampling during the procedure. There were no complications. The largest omentum removed was 25 x 37 cm and weighed 560 g. Various modalities were employed, including the endoscopic linear stapler, and bipolar and monopolar electrosurgery.
Operative Laparoscopy in Elderly Women GM Boike, G Hagopian, JE Graham Jr. Hurley Medical Center, Flint, MI.
Several reports in the literature address the issue of surgery in elderly women with gynecologic cancer,
$4
Laparoscopic Approach to the Space of Retzius
to patient satisfaction. Therefore, we have also started to perform certain operative techniques at the same time as the diagnostic procedure, with a small-diameter rigid hysteroscope (4.5 mm with operative sheath). At this time, cervical polyps of any dimensions, polyps and pedunculated myomas smaller than 1.5 cm, pedunculated polyps with bases larger than 1.5 cm, and uterine septae are treated with scissors and forceps on an outpatient basis. The innervation of the uterus is such that the procedures cause no pain if they are performed on the endometrium. In fact, pain is associated only with manipulation and stretching of the myometrium. The future of this new approach depends on the design of new instruments with which it will be possible to perform more complex operations without anesthesia.
S Bhoughizane, A Wattiez, M Canis, F Alexandre, C Pomel, JL Pouly, G Mage, MA Bruhat. Polyclinique de I'Hotel Dieu, Universite de Clermont-Ferrand I, Clermont-Ferrand, France.
The Actual Role of Contact Hysteroscopy
Endoscopic techniques allow us to understand better the anatomy of the space of Retzius. All techniques thus far described are blind or semiblind. For the first time, laparoscopy allows the placement of a suture or staple to be precise and confirmed. With knowledge and recognition of the anatomy, this technique does not simply accomplish what older ones did, but does it better. Our study describes the anatomy of the prevesical space of Retzius, identifies the structure, and points out some anatomic landmarks that ensure the success of this technique.
S Bettocchi, G Loverro, N Pansini, L Selvaggi. Department of Gynecology and Obstetrics "R," University of Bari, Bari, Italy.
Laparoscopic Omentectomy in Staging and Treating Gynecologic Cancers GM Boike, JE Graham Jr. Hurley Medical Center, Flint, MI.
The role of contact hysteroscopy is totally different from that described by Baggish in 1979, because new instruments vary the degree of magnification from panoramic vision to 80x. Whereas in the past contact hysteroscopy was an economical, although less efficacious, alternative to hysteroscopy with distention of the uterine cavity, now it is an effective alternative to traditional panoramic hysteroscopy. In 1986 a new procedure, hysteroscopic dating of the endometrium, was introduced in which it was possible to stage the exact phase of the cycle by positioning the hysteroscope on the endometrial surface and visualizing the vascular pattern up to 80x magnification. With the experience gained with this procedure, it was noticed that, besides the physiologic patterns, other abnormal dysfunctional patterns were present that were classified as pseudofunctional dysvascular endometrium (PFDE). It was initially hard to interpret these patterns until a possible correlation was observed between PFDE and dysfunctional uterine bleeding on the one hand, and PFDE and hidden forms of endometrial hyperplasia on the other. Due to the ability to visualize the endometrial surface with wide magnification, contact hysteroscopy is now helpful in establishing the diagnosis of benign uterine pathologies (polyps, myomas) as well as endometrial hyperplasia.
Infracolic omentectomy is an integral part of staging ovarian cancer and a therapeutic maneuver in advanced ovarian pelvic and aortic lymph node sampling. Laparoscopic infracolic omentectomy in the staging of gynecologic cancers is both feasible and safe. From October 1992 through January 1995, 15 laparoscopic omentectomies were performed on our gynecologic oncology service in women whose ages ranged from 25 to 74 years. Thirteen were performed as part of staging ovarian cancer, one for tubal cancer, and one for stage IV endometrial cancer with gross tumor metastases. Eleven patients also underwent laparoscopic retroperitoneal lymph node sampling during the procedure. There were no complications. The largest omentum removed was 25 x 37 cm and weighed 560 g. Various modalities were employed, including the endoscopic linear stapler, and bipolar and monopolar electrosurgery.
Operative Laparoscopy in Elderly Women GM Boike, G Hagopian, JE Graham Jr. Hurley Medical Center, Flint, MI.
Several reports in the literature address the issue of surgery in elderly women with gynecologic cancer,
$4