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Total Laparoscopic Radical Hysterectomy and Robotic Radical Hysterectomy with Pelvic Lymphadenectomy in Treatment of Early Cervical Cancer: Recurrence and Survival
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Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159
lower in laparoscopy group compared with laparotomy group (2.6 1.5 mg/dl vs. 9.1 5.4 mg/dl, p!0.05). The length of hospital admission was significantly shortened in the laparoscopy group compared with the laparotomy group (3.3 0.7 days vs. 9.2 2.5 days, p!0.05). There were no significant differences in the operation time, postoperative body temperature and the first diet after surgery between the two groups. No idiopathic injury occurred during operations. Conclusion: Our findings suggested that laparoscopic adhesiotomy using SURGIWANDÔ and the Uterine Manipulator is a safe and effective treatment for ovarian and pelvic endometriosis patients with cul de sac obliteration.
471 Use of the LapCap Device for Blind Veress Needle Passage in 40 Laparoscopic Patients Presthus JB, Beadle EM. Gynecology, Minnesota Gynecology and Surgery, Edina, Minnesota Study Objective: To demonstrate the safety and efficacy of the LapCap device for blind Veress needle passage. Design: Prospective, single-arm, open label trial. Setting: Midwestern urban gynecologic practice; private hospitals. Patients: 40 women (mean age 40 years, mean BMI 26) undergoing elective laparoscopic procedures in whom blind 12 cm peri-umbilical Veress needle passage was clinically appropriate. Intervention: The LapCapÔ is a commercially available device which elevates the abdominal wall using standard O.R. suction, assisting the surgeon in blind Veress needle passage. The device is designed to protect retroperitoneal vessels and organs from injury when used with a 12 cm needle. 40 Subjects underwent blind 12 cm needle passage using the LapCap. Measurements and Main Results: 75% of Subjects (30 women) had previous abdominal and/or pelvic surgery, including 35% (14) with multiple previous procedures. In one method of use, mean needle passage time following peri-umbilical LapCap placement was 3.9 seconds. First pass failure occurred in 2 women (5%) secondary to inadequate needle length (the LapCap has since received FDA clearance for use with 15 cm Veress needles). During a mean post-operative follow-up of 25 days, three minor adverse events were noted, all of which resolved spontaneously and without clinical sequelae: mild skin abrasion as a result of incompletely dried surgical skin preparation at the time of suction application to the device, and minor petechial changes within the device suction zone (2 Subjects). Conclusion: In this population, including 75% with prior abdominal and/or pelvic surgery (35% with multiple previous operations), the LapCap allowed for rapid blind 12 cm Veress needle passage with only a 5% first pass failure rate. Designed to prevent rare but potentially catastrophic retroperitoneal vessel injuries, the device demonstrated safety. Unlike standard lifting techniques, the single-operator LapCap is simple and physically effortless to use and leaves the patient with no penetrating clamp wounds.
ONCOLOGY 471.5 Total Laparoscopic Radical Hysterectomy and Robotic Radical Hysterectomy with Pelvic Lymphadenectomy in Treatment of Early Cervical Cancer: Recurrence and Survival Nezhat FR, Datta MS, Liu CS, Chuang L, Rahaman J, Zakashansky K. Obstetrics, Gynecology, and Reproductive Health, Mount Sinai Medical Center, New York, New York; Department of Obstetrics and Gynecology, St. Luke’s Roosevelt, New York, New York Study Objective: To evaluate recurrence and survival rates among patients with early stage cervical cancer who were treated with either total laparoscopic (TLRH) or robotic radical hysterectomy (RRH) with pelvic lymphadenectomy.
Design: Retrospective analysis of patients who underwent either TLRH or RRH with bilateral pelvic lymphadenectomy from August 2000 to May 2008. Setting: Single university-based hospital with a gynecologic oncology fellowship program. Patients: A total of 49 patients with early stage cervical cancer desiring minimally invasive surgical treatment. Intervention: Either TLRH or RRH with pelvic lymphadenectomy. Measurements and Main Results: 30 patients underwent total laparoscopic radical hysterectomy and 19 underwent robotic radical hysterectomy with pelvic lymphadenectomy. One patient had squamous cell carcinoma in situ, one had adenocarcinoma in situ for a positive endocervical margin on conization. Two patients were stage IA1; 9 were stage IA2; 32 patients were stage IB1; 3 were stage IB2; and 3 patients were stage IIA. Pathological risk factors for disease recurrence were analyzed: one patient had a positive parametrial margin; six patients had positive lymph nodes: 4 pelvics and 2 parametrial nodes. Eleven patients had an outer third cervical wall invasion, 5 of patients had cervical lesion greater than 2 cm, and twenty-two patients (44%) had lymphovascular invasion. Based on a combination of these risk factors, nineteen patients (39%) underwent adjuvant chemoradiation. Follow-up has been provided every 3 months, and with a median follow up of 20 months all the patients are alive with no documented recurrences. Conclusion: Based on our intermediate-term follow-up, total laparoscopic radical hysterectomy or robotic assisted radical hysterectomy seem to be safe alternatives to traditional open abdominal approach for treatment of early stage cervical cancer with respect to disease recurrence and overall survival based on our Intermediate-term follow-up.
472 Papillary Serous Carcinoma of the Cervix: Case Report Al-wahab Z,1 Malone J Jr,2 Bryant C,2 Shah JP,2 Vay A,2 Ali R,2 Solomon L,2 Morris RT.2 1Obstetrics and Gynecology, Wayne State University/Detroit Medical Center, Detroit, Michigan; 2Gynecology Oncology, Karmanos Cancer Institute, Detroit, Michigan Study Objective: To present two rare cases of papillary serous carcinoma of the cervix. Design: Case Report. Setting: Karmanos Cancer Institute. Patients: Two cases of papillary serous carcinoma of the cervix reported. Intervention: The first patient is a thirty-three-year-old with clinical stage IB1 disease. The patient underwent Robotic assisted radical trachelectomy with bilateral pelvic lymphadenectomy followed by four cycles of Carboplatin and Taxol. The patient is alive with no evidence of the disease after 24 months. The second patient is a seventy-four-year-old with history of supra-cervical hysterectomy in 1970 for uterine fibroids. The patient was diagnosed with stage IV papillary serous carcinoma in 1998. She underwent multiple cycles of chemotherapy and pelvic radiation therapy with recurrences. The patient now is alive with a stable disease and she decided to continue on observation alone.
Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159
lower in laparoscopy group compared with laparotomy group (2.6 1.5 mg/dl vs. 9.1 5.4 mg/dl, p!0.05). The length of hospital admission was significantly shortened in the laparoscopy group compared with the laparotomy group (3.3 0.7 days vs. 9.2 2.5 days, p!0.05). There were no significant differences in the operation time, postoperative body temperature and the first diet after surgery between the two groups. No idiopathic injury occurred during operations. Conclusion: Our findings suggested that laparoscopic adhesiotomy using SURGIWANDÔ and the Uterine Manipulator is a safe and effective treatment for ovarian and pelvic endometriosis patients with cul de sac obliteration.
471 Use of the LapCap Device for Blind Veress Needle Passage in 40 Laparoscopic Patients Presthus JB, Beadle EM. Gynecology, Minnesota Gynecology and Surgery, Edina, Minnesota Study Objective: To demonstrate the safety and efficacy of the LapCap device for blind Veress needle passage. Design: Prospective, single-arm, open label trial. Setting: Midwestern urban gynecologic practice; private hospitals. Patients: 40 women (mean age 40 years, mean BMI 26) undergoing elective laparoscopic procedures in whom blind 12 cm peri-umbilical Veress needle passage was clinically appropriate. Intervention: The LapCapÔ is a commercially available device which elevates the abdominal wall using standard O.R. suction, assisting the surgeon in blind Veress needle passage. The device is designed to protect retroperitoneal vessels and organs from injury when used with a 12 cm needle. 40 Subjects underwent blind 12 cm needle passage using the LapCap. Measurements and Main Results: 75% of Subjects (30 women) had previous abdominal and/or pelvic surgery, including 35% (14) with multiple previous procedures. In one method of use, mean needle passage time following peri-umbilical LapCap placement was 3.9 seconds. First pass failure occurred in 2 women (5%) secondary to inadequate needle length (the LapCap has since received FDA clearance for use with 15 cm Veress needles). During a mean post-operative follow-up of 25 days, three minor adverse events were noted, all of which resolved spontaneously and without clinical sequelae: mild skin abrasion as a result of incompletely dried surgical skin preparation at the time of suction application to the device, and minor petechial changes within the device suction zone (2 Subjects). Conclusion: In this population, including 75% with prior abdominal and/or pelvic surgery (35% with multiple previous operations), the LapCap allowed for rapid blind 12 cm Veress needle passage with only a 5% first pass failure rate. Designed to prevent rare but potentially catastrophic retroperitoneal vessel injuries, the device demonstrated safety. Unlike standard lifting techniques, the single-operator LapCap is simple and physically effortless to use and leaves the patient with no penetrating clamp wounds.
ONCOLOGY 471.5 Total Laparoscopic Radical Hysterectomy and Robotic Radical Hysterectomy with Pelvic Lymphadenectomy in Treatment of Early Cervical Cancer: Recurrence and Survival Nezhat FR, Datta MS, Liu CS, Chuang L, Rahaman J, Zakashansky K. Obstetrics, Gynecology, and Reproductive Health, Mount Sinai Medical Center, New York, New York; Department of Obstetrics and Gynecology, St. Luke’s Roosevelt, New York, New York Study Objective: To evaluate recurrence and survival rates among patients with early stage cervical cancer who were treated with either total laparoscopic (TLRH) or robotic radical hysterectomy (RRH) with pelvic lymphadenectomy.
Design: Retrospective analysis of patients who underwent either TLRH or RRH with bilateral pelvic lymphadenectomy from August 2000 to May 2008. Setting: Single university-based hospital with a gynecologic oncology fellowship program. Patients: A total of 49 patients with early stage cervical cancer desiring minimally invasive surgical treatment. Intervention: Either TLRH or RRH with pelvic lymphadenectomy. Measurements and Main Results: 30 patients underwent total laparoscopic radical hysterectomy and 19 underwent robotic radical hysterectomy with pelvic lymphadenectomy. One patient had squamous cell carcinoma in situ, one had adenocarcinoma in situ for a positive endocervical margin on conization. Two patients were stage IA1; 9 were stage IA2; 32 patients were stage IB1; 3 were stage IB2; and 3 patients were stage IIA. Pathological risk factors for disease recurrence were analyzed: one patient had a positive parametrial margin; six patients had positive lymph nodes: 4 pelvics and 2 parametrial nodes. Eleven patients had an outer third cervical wall invasion, 5 of patients had cervical lesion greater than 2 cm, and twenty-two patients (44%) had lymphovascular invasion. Based on a combination of these risk factors, nineteen patients (39%) underwent adjuvant chemoradiation. Follow-up has been provided every 3 months, and with a median follow up of 20 months all the patients are alive with no documented recurrences. Conclusion: Based on our intermediate-term follow-up, total laparoscopic radical hysterectomy or robotic assisted radical hysterectomy seem to be safe alternatives to traditional open abdominal approach for treatment of early stage cervical cancer with respect to disease recurrence and overall survival based on our Intermediate-term follow-up.
472 Papillary Serous Carcinoma of the Cervix: Case Report Al-wahab Z,1 Malone J Jr,2 Bryant C,2 Shah JP,2 Vay A,2 Ali R,2 Solomon L,2 Morris RT.2 1Obstetrics and Gynecology, Wayne State University/Detroit Medical Center, Detroit, Michigan; 2Gynecology Oncology, Karmanos Cancer Institute, Detroit, Michigan Study Objective: To present two rare cases of papillary serous carcinoma of the cervix. Design: Case Report. Setting: Karmanos Cancer Institute. Patients: Two cases of papillary serous carcinoma of the cervix reported. Intervention: The first patient is a thirty-three-year-old with clinical stage IB1 disease. The patient underwent Robotic assisted radical trachelectomy with bilateral pelvic lymphadenectomy followed by four cycles of Carboplatin and Taxol. The patient is alive with no evidence of the disease after 24 months. The second patient is a seventy-four-year-old with history of supra-cervical hysterectomy in 1970 for uterine fibroids. The patient was diagnosed with stage IV papillary serous carcinoma in 1998. She underwent multiple cycles of chemotherapy and pelvic radiation therapy with recurrences. The patient now is alive with a stable disease and she decided to continue on observation alone.