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Laparoscopic Optimal Debulking Surgery for Ovarian Cancer
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Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159
this plexus supplying the uterus were selectively cut, preserving the nerves to the bladder. Uroflowmetric studies were normal in 5 patients. All patients had tumor free margins. Four patients reported unaltered sexual activity.
115
Video Session 4dOncology (4:02 AM d 4:10 AM)
Two Step Laparoscopic Vascular Injury Repair Andou M. Gynecology, Kurashiki Medical Center, Kurashiki-shi, Okayama-ken, Japan Objective: We have introduced an open vascular suturing technique into the laparoscopic environment to avoid conversion to laparotomy when accidental vascular injury and massive bleeding occur during laparoscopic retroperitoneal dissection. Methods: Three vascular injury repair scenarios will be presented. Case one suffered an avulsion injury of the IVC during retroperitoneoscopic para-aortic dissection. Case two suffered deep pelvic bleeding due to the laceration of the posterior aspect of the external iliac vein during a laparoscopic pelvic lymphadenectomy. Case three suffered the accidental partial severing of the external iliac artery by monopolarcautery during a pelvic lymphadenectomy. To maintain a blood-free operative field we used various laparoscopic vascular clamps for temporary hemostasis and looped vascular tape to control bleeding. The defects were then repaired with intracorporeal suturing for permanent hemostasis. Results: There was no conversion to laparotomy or vasucular complications like thrombosis or stenosis. Intracorporeal vascular suturing proved successful both laparo/retroperitoneoscopically.
116
Video Session 4dOncology (4:11 AM d 4:19 AM)
Laparoscopic Debulking in Stage IIIC Ovarian Cancer e Our Experience: Video Presentation Patil AM, Puntambekar SP, Puntambekar SS, Kashyap MA, Kulkarni MA. Gynecological Oncology, Galaxy Laparoscopy Institute, Pune, Maharashtra, India Introduction: The role of laparoscopy in the management of ovarian cancer has always been a point of debate. The major concern is the bulk of the tumor, the extensive nature of the surgery and the upstaging of the disease. Purpose: To demonstrate the feasibility and safety of laparoscopic debulking in stage III c ovarian cancer. Intervention: Staging laparoscopy with debulking procedure was done in nine patients having advanced cancer ovary with ascites and peritoneal metastases (n 5 6: known cases, had received chemotherapy in the past, n 5 3: primary cases). All patients underwent an optimal debulking (n 5 5, hysterectomy with bilateral salphingoopherectomy and omentectomy, n 5 2, posterior exenteration with omentectomy, n 5 1, total pelvic exenteration with omentectomy, n 5 1, unilateral oophorectomy with omentectomy). All patients received postoperative chemotherapy. Conclusion: Laparoscopic debulking for advanced cancer ovary is feasible, since there is no issue of intraperitoneal spillage of tumor cells and it has obvious advantages of laparoscopy over open surgery.
117
Video Session 4dOncology (4:20 AM d 4:28 AM)
Hand-Assisted Laparoscopic Splenectomy Brown J, Bevers MW, Ramirez PT, Frumovitz M. Department of Gynecologic Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas This video demonstrates hand-assisted laparoscopic splenectomy in a patient with an isolated recurrence of ovarian cancer. Appropriate positioning and surgical technique is clearly shown and described, with pertinent surgical points illustrated to avoid injury and obtain optimal results.
118
Video Session 4dOncology (4:29 AM d 4:34 AM)
Macroscopic Para-Aortic Metastasis in Locally Advanced Cervical Cancer with Negative Imaging Ramirez PT, Soliman PT, Pareja R, Schmeler KM. Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas Imaging studies such as CT, MRI, or PET/CT are often performed to determine extent of disease and ultimately radiation fields in patients with locally advanced cervical cancer. At the University of Texas, MD Anderson Cancer Center, we are currently conducting a prospective trial evaluating the accuracy of PET/CT in the diagnosis of para-aortic metastases in patients with locally advanced cervical cancer. Patients with negative CT scans undergo a preoperative PET/CT followed by laparoscopic retroperitoneal para-aortic lymphadenectomy. The following video is of a 38-year-old female with clinical stage IIIA squamous cell carcinoma of the cervix. Although her preoperative CT and PET/CT scans revealed no evidence of para-aortic adenopathy, she had grossly positive nodes at the time of her procedure.
119
Video Session 4dOncology (4:35 AM d 4:43 AM)
Laparoscopic Total Pelvic Exenteration: Palliation for Advanced Carcinoma Cervix Puntambekar SP, Kulkarni MA, Patil AM, Puntambekar SS. Gynecological Oncology, Galaxy Laparoscopy Institute, Pune, Maharashtra, India Introduction: The optimal treatment for locally advanced, recurrent and metastatic cervical cancer is a dilemma. Sometimes, an extensive surgery like exenteration is the only hope for symptomatic relief, if not cure in such patients. Purpose: To demonstrate the technique of Laparoscopic Total Pelvic exenteration (TPE) and promote this procedure in select group of patients. Intervention: We performed this procedure in 7 patients, beginning with a diagnostic scopy to assess resectibility of the tumor (tumors involving the external iliac vessels were considered unresectable). Planes of dissection were the presacral space, pararectal spaces and prevesical space. Patients underwent a low anterior resection with an ileal conduit. All patients had immediate symptom relief. Conclusion: Laparoscopic TPE is a less morbid procedure when compared to its open counterpart. It should be included in the oncosurgeons armamentarium as a method of palliation for advanced carcinoma cervix.
120
Video Session 4dOncology (4:44 AM d 4:50 AM)
Laparoscopic Optimal Debulking Surgery for Ovarian Cancer Choi JS. Obstetrics and Gynecology, Kangbuk Samsung Hospital, Seoul, Republic of Korea The aim of this video was to find the feasibility of laparoscopic optimal debulking surgery for ovarian cancer FIGO Stage IIIC. This operation, performed by a specialized laparoscopic oncologist with sufficient laparoscopic experience and a well-trained operating team, is both feasible and effective in treating ovarian cancers.
121
Video Session 4dOncology (4:51 AM d 4:59 AM)
Robotic Radical Trachelectomy for Preservation of Fertility in Early Cervical Cancer: Description of Technique Burnett AF, Stone PJB, Sellers M, Roman JJ. Ob Gyn, University of Arkansas for Medical Sciences, Little Rock, Arkansas Radical trachelectomy permits preservation of fertility in select cases of early cervical cancer. Traditionally, this procedure is performed by
Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159
this plexus supplying the uterus were selectively cut, preserving the nerves to the bladder. Uroflowmetric studies were normal in 5 patients. All patients had tumor free margins. Four patients reported unaltered sexual activity.
115
Video Session 4dOncology (4:02 AM d 4:10 AM)
Two Step Laparoscopic Vascular Injury Repair Andou M. Gynecology, Kurashiki Medical Center, Kurashiki-shi, Okayama-ken, Japan Objective: We have introduced an open vascular suturing technique into the laparoscopic environment to avoid conversion to laparotomy when accidental vascular injury and massive bleeding occur during laparoscopic retroperitoneal dissection. Methods: Three vascular injury repair scenarios will be presented. Case one suffered an avulsion injury of the IVC during retroperitoneoscopic para-aortic dissection. Case two suffered deep pelvic bleeding due to the laceration of the posterior aspect of the external iliac vein during a laparoscopic pelvic lymphadenectomy. Case three suffered the accidental partial severing of the external iliac artery by monopolarcautery during a pelvic lymphadenectomy. To maintain a blood-free operative field we used various laparoscopic vascular clamps for temporary hemostasis and looped vascular tape to control bleeding. The defects were then repaired with intracorporeal suturing for permanent hemostasis. Results: There was no conversion to laparotomy or vasucular complications like thrombosis or stenosis. Intracorporeal vascular suturing proved successful both laparo/retroperitoneoscopically.
116
Video Session 4dOncology (4:11 AM d 4:19 AM)
Laparoscopic Debulking in Stage IIIC Ovarian Cancer e Our Experience: Video Presentation Patil AM, Puntambekar SP, Puntambekar SS, Kashyap MA, Kulkarni MA. Gynecological Oncology, Galaxy Laparoscopy Institute, Pune, Maharashtra, India Introduction: The role of laparoscopy in the management of ovarian cancer has always been a point of debate. The major concern is the bulk of the tumor, the extensive nature of the surgery and the upstaging of the disease. Purpose: To demonstrate the feasibility and safety of laparoscopic debulking in stage III c ovarian cancer. Intervention: Staging laparoscopy with debulking procedure was done in nine patients having advanced cancer ovary with ascites and peritoneal metastases (n 5 6: known cases, had received chemotherapy in the past, n 5 3: primary cases). All patients underwent an optimal debulking (n 5 5, hysterectomy with bilateral salphingoopherectomy and omentectomy, n 5 2, posterior exenteration with omentectomy, n 5 1, total pelvic exenteration with omentectomy, n 5 1, unilateral oophorectomy with omentectomy). All patients received postoperative chemotherapy. Conclusion: Laparoscopic debulking for advanced cancer ovary is feasible, since there is no issue of intraperitoneal spillage of tumor cells and it has obvious advantages of laparoscopy over open surgery.
117
Video Session 4dOncology (4:20 AM d 4:28 AM)
Hand-Assisted Laparoscopic Splenectomy Brown J, Bevers MW, Ramirez PT, Frumovitz M. Department of Gynecologic Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas This video demonstrates hand-assisted laparoscopic splenectomy in a patient with an isolated recurrence of ovarian cancer. Appropriate positioning and surgical technique is clearly shown and described, with pertinent surgical points illustrated to avoid injury and obtain optimal results.
118
Video Session 4dOncology (4:29 AM d 4:34 AM)
Macroscopic Para-Aortic Metastasis in Locally Advanced Cervical Cancer with Negative Imaging Ramirez PT, Soliman PT, Pareja R, Schmeler KM. Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas Imaging studies such as CT, MRI, or PET/CT are often performed to determine extent of disease and ultimately radiation fields in patients with locally advanced cervical cancer. At the University of Texas, MD Anderson Cancer Center, we are currently conducting a prospective trial evaluating the accuracy of PET/CT in the diagnosis of para-aortic metastases in patients with locally advanced cervical cancer. Patients with negative CT scans undergo a preoperative PET/CT followed by laparoscopic retroperitoneal para-aortic lymphadenectomy. The following video is of a 38-year-old female with clinical stage IIIA squamous cell carcinoma of the cervix. Although her preoperative CT and PET/CT scans revealed no evidence of para-aortic adenopathy, she had grossly positive nodes at the time of her procedure.
119
Video Session 4dOncology (4:35 AM d 4:43 AM)
Laparoscopic Total Pelvic Exenteration: Palliation for Advanced Carcinoma Cervix Puntambekar SP, Kulkarni MA, Patil AM, Puntambekar SS. Gynecological Oncology, Galaxy Laparoscopy Institute, Pune, Maharashtra, India Introduction: The optimal treatment for locally advanced, recurrent and metastatic cervical cancer is a dilemma. Sometimes, an extensive surgery like exenteration is the only hope for symptomatic relief, if not cure in such patients. Purpose: To demonstrate the technique of Laparoscopic Total Pelvic exenteration (TPE) and promote this procedure in select group of patients. Intervention: We performed this procedure in 7 patients, beginning with a diagnostic scopy to assess resectibility of the tumor (tumors involving the external iliac vessels were considered unresectable). Planes of dissection were the presacral space, pararectal spaces and prevesical space. Patients underwent a low anterior resection with an ileal conduit. All patients had immediate symptom relief. Conclusion: Laparoscopic TPE is a less morbid procedure when compared to its open counterpart. It should be included in the oncosurgeons armamentarium as a method of palliation for advanced carcinoma cervix.
120
Video Session 4dOncology (4:44 AM d 4:50 AM)
Laparoscopic Optimal Debulking Surgery for Ovarian Cancer Choi JS. Obstetrics and Gynecology, Kangbuk Samsung Hospital, Seoul, Republic of Korea The aim of this video was to find the feasibility of laparoscopic optimal debulking surgery for ovarian cancer FIGO Stage IIIC. This operation, performed by a specialized laparoscopic oncologist with sufficient laparoscopic experience and a well-trained operating team, is both feasible and effective in treating ovarian cancers.
121
Video Session 4dOncology (4:51 AM d 4:59 AM)
Robotic Radical Trachelectomy for Preservation of Fertility in Early Cervical Cancer: Description of Technique Burnett AF, Stone PJB, Sellers M, Roman JJ. Ob Gyn, University of Arkansas for Medical Sciences, Little Rock, Arkansas Radical trachelectomy permits preservation of fertility in select cases of early cervical cancer. Traditionally, this procedure is performed by