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Robotic Lymph Node Dissection: Anatomy and Surgical Techniques
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
S115
Table 2 Numbers are % (Count/Sample Size) or meanSD (N) (min,median,max) PROCEDURE RESULTS Pathology Type Myomas Type 0 Type 1 Polyps Fluid Deficit (mL) Myoma Procedures Polyp Procedures Myoma & Polyp Procedures
N
Pathology Size (cm3)
Tissue Resection Time (seconds)
8 75.0% (6/8) 25.0% (2/8) 8
10.71 10.00 (8) (3.33, 7.63, 32.76) 8.19 5.08 (6) (3.33, 7.63, 14.98) 18.28 20.47 (2) (3.81, 18.28, 32.76) 318.08 88.63 (8) (0.03, 1.22, 2511.7)
494.65 455.54 (8) (78.20, 386.50, 1340.00) 566.03 500.62 (6) (78.2, 414.5, 1340.00) 280.5 277.89 (2) (84.00, 280.50, 477.00) 26.85 39.75 (8) (0.95, 8.98, 114.00)
5 3 2
1380.00 724.22 (550.00, 1250.00, 2350.00) 486.67 100.17 (410.00, 450.00, 600.00) 1050.00 565.69 (650.00, 1050.00, 1450.00)
295 Laparoscopic Radical Trachelectomy in a Young Patient With Early Cervical Cancer Lee C-L, Huang K-G, Wu K-Y, Huang C-Y, Kuo H-H. Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
dense, calcified myomas that otherwise might be unresectable in an office setting.
This 29 year-old female, G1P1, was diagnosed with cervical adenocarcinoma, FIGO stage IB1. Patient preferred laparoscopic radical trachelectomy (LRT) with bilateral pelvic lymphadenectomy and prophylactic cervical cerclage. We dissected uterine artery from internal iliac artery till the division of ascending and descending branch, the bladder down to 2cm distal to cervix, opened the ureter tunnel and then excised parametrium and paracolpium. Final pathology showed focal adenocarcinoma in situ and all other specimen was negative for malignancy. With the magnification of laparoscopy, we can illustrate all the detail structures clearly, which is the most important advantage of laparoscopic approach for radical trachelectomy when compared with laparotomy. Moreover, vaginal cerclage before reanastomosis of vagina and cervix is much easier to perform. This video demonstrated the safety and feasibility of LRT, indicated for young patients who desire fertility preservation.
TUESDAY, NOVEMBER 17, 2015 294
Video Session 1 - Oncology (11:00 AM - 12:00 PM)
296
Robotic Lymph Node Dissection: Anatomy and Surgical Techniques Truong MD, Jorge S, Burke WM. Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York
Robotic Laparoendoscopic Single Site Radical Hysterectomy With Sentinel Lymph Node Mapping and Pelvic Lymphadenectomy for Cervical Cancer Sinno AK, Tanner EJ. The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland
Pelvic and para-aortic lymph node dissection involves the removal of nodal tissue within an area bordered by well-defined anatomic landmarks, from the inferior mesenteric artery superiorly to the obturator space inferiorly. It is indicated in the surgical staging of uterine, ovarian, cervical and vaginal cancer. Minimally invasive approaches to lymph node dissection have been shown to be feasible and safe but require knowledge of anatomy, especially the retroperitoneal space, and good surgical technique. The objective of this video is to serve as an educational tool for medical students, residents and fellows. Pelvic anatomy is reviewed through schematics and anatomical landmarks and highlighted throughout the video. The major steps of a pelvic and para-aortic lymphadenectomy are explained. Dissection techniques including grasp & tent, push & spread, traction & counter-traction, gentle wiping & teasing are illustrated. An example of recognition and management of injury to a major blood vessel is demonstrated.
Minimally invasive radical hysterectomy is becoming increasingly utilized Initial surgical management for early stage cervical carcinoma due decreased morbidity as compared to traditional open surgery. Sentinel lymph node mapping has also been proposed as a less invasive approach to traditional lymphadenectomy in this setting. Furthermore, single port laparoscopy has been described in the management of cervical cancer but has not gained traction due to the steep learning curve and the complexity of the procedure. Robotic surgery can potentially overcome the hurdles that have contributed the lack of its adoption. In this video, we present the first case of robotic single site radical hysterectomy, sentinel lymph node mapping with near infrared imaging guidance, followed by full pelvic lymphadenectomy for stage 1B1 cervical carcinoma. Operative time was 320 minutes and EBL was 200ml. The patient was discharged home on postoperative day 1 and did not require any adjuvant therapy.
S115
Table 2 Numbers are % (Count/Sample Size) or meanSD (N) (min,median,max) PROCEDURE RESULTS Pathology Type Myomas Type 0 Type 1 Polyps Fluid Deficit (mL) Myoma Procedures Polyp Procedures Myoma & Polyp Procedures
N
Pathology Size (cm3)
Tissue Resection Time (seconds)
8 75.0% (6/8) 25.0% (2/8) 8
10.71 10.00 (8) (3.33, 7.63, 32.76) 8.19 5.08 (6) (3.33, 7.63, 14.98) 18.28 20.47 (2) (3.81, 18.28, 32.76) 318.08 88.63 (8) (0.03, 1.22, 2511.7)
494.65 455.54 (8) (78.20, 386.50, 1340.00) 566.03 500.62 (6) (78.2, 414.5, 1340.00) 280.5 277.89 (2) (84.00, 280.50, 477.00) 26.85 39.75 (8) (0.95, 8.98, 114.00)
5 3 2
1380.00 724.22 (550.00, 1250.00, 2350.00) 486.67 100.17 (410.00, 450.00, 600.00) 1050.00 565.69 (650.00, 1050.00, 1450.00)
295 Laparoscopic Radical Trachelectomy in a Young Patient With Early Cervical Cancer Lee C-L, Huang K-G, Wu K-Y, Huang C-Y, Kuo H-H. Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
dense, calcified myomas that otherwise might be unresectable in an office setting.
This 29 year-old female, G1P1, was diagnosed with cervical adenocarcinoma, FIGO stage IB1. Patient preferred laparoscopic radical trachelectomy (LRT) with bilateral pelvic lymphadenectomy and prophylactic cervical cerclage. We dissected uterine artery from internal iliac artery till the division of ascending and descending branch, the bladder down to 2cm distal to cervix, opened the ureter tunnel and then excised parametrium and paracolpium. Final pathology showed focal adenocarcinoma in situ and all other specimen was negative for malignancy. With the magnification of laparoscopy, we can illustrate all the detail structures clearly, which is the most important advantage of laparoscopic approach for radical trachelectomy when compared with laparotomy. Moreover, vaginal cerclage before reanastomosis of vagina and cervix is much easier to perform. This video demonstrated the safety and feasibility of LRT, indicated for young patients who desire fertility preservation.
TUESDAY, NOVEMBER 17, 2015 294
Video Session 1 - Oncology (11:00 AM - 12:00 PM)
296
Robotic Lymph Node Dissection: Anatomy and Surgical Techniques Truong MD, Jorge S, Burke WM. Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, New York
Robotic Laparoendoscopic Single Site Radical Hysterectomy With Sentinel Lymph Node Mapping and Pelvic Lymphadenectomy for Cervical Cancer Sinno AK, Tanner EJ. The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland
Pelvic and para-aortic lymph node dissection involves the removal of nodal tissue within an area bordered by well-defined anatomic landmarks, from the inferior mesenteric artery superiorly to the obturator space inferiorly. It is indicated in the surgical staging of uterine, ovarian, cervical and vaginal cancer. Minimally invasive approaches to lymph node dissection have been shown to be feasible and safe but require knowledge of anatomy, especially the retroperitoneal space, and good surgical technique. The objective of this video is to serve as an educational tool for medical students, residents and fellows. Pelvic anatomy is reviewed through schematics and anatomical landmarks and highlighted throughout the video. The major steps of a pelvic and para-aortic lymphadenectomy are explained. Dissection techniques including grasp & tent, push & spread, traction & counter-traction, gentle wiping & teasing are illustrated. An example of recognition and management of injury to a major blood vessel is demonstrated.
Minimally invasive radical hysterectomy is becoming increasingly utilized Initial surgical management for early stage cervical carcinoma due decreased morbidity as compared to traditional open surgery. Sentinel lymph node mapping has also been proposed as a less invasive approach to traditional lymphadenectomy in this setting. Furthermore, single port laparoscopy has been described in the management of cervical cancer but has not gained traction due to the steep learning curve and the complexity of the procedure. Robotic surgery can potentially overcome the hurdles that have contributed the lack of its adoption. In this video, we present the first case of robotic single site radical hysterectomy, sentinel lymph node mapping with near infrared imaging guidance, followed by full pelvic lymphadenectomy for stage 1B1 cervical carcinoma. Operative time was 320 minutes and EBL was 200ml. The patient was discharged home on postoperative day 1 and did not require any adjuvant therapy.