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Two-Port Access Staging Laparoscopy for Endometrial Cancer: A Pilot Study
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S109–S127 ORAL PRESENTATIONS PART 6 376
Open Communications 22dRobotics (8:54 AM d 8:59 AM)
Urinary Retention: Is It a Common Complication of Robot Assisted Laparoscopic Hysterectomy? Smorgick-Rosenbaum N, Patzkowsky K, Hassouneh S, Song A, Advincula A, As-Sanie S. Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, Michigan Study Objective: To investigate the occurrence of urinary retention following laparoscopic hysterectomy by traditional laparoscopic approach and robot-assisted approach. Design: IRB-approved retrospective chart review. Setting: A university hospital tertiary referral center. Patients: All patients who underwent laparoscopic hysterectomy via a traditional laparoscopic approach (N=242) and a robotic-assisted approach (n=248) from 3/2000 until 12/2009 for benign indications at the University of Michigan Health System. Urinary retention was defined as an inability to spontaneously void following removal of the Foley catheter on post-operative day 1, and requiring either self catheterization or Foley replacement. Intervention: Laparoscopic or robot-assisted total/supracervical hysterectomy. Measurements and Main Results: Urinary retention occurred in 36/490 (7.4%) women. There were no statistically significant differences between women who developed urinary retention compared with those who did not in terms of age, BMI, presence of diabetes, smoking status, number of previous abdominal surgeries, and number of prior cesarean sections. Regarding the surgical characteristics, urinary retention was more common among women who underwent a robotassisted hysterectomy compared with traditional laparoscopic hysterectomy [25 (10.1%) cases versus 11 (4.5%) cases, p=.02]. Other surgical characteristics such as uterine weight, severe adhesions, total versus supracervical hysterectomy and presence of endometriosis were similar in women who developed urinary retention compared with those who did not. The main complication from urinary retention was lower urinary tract infection, occurring in 5/36 (13.9%) cases. However, none of these women developed pyelonephritis, and none required readmission. Conclusion: Urinary retention appears to be a relatively common complication of robot-assisted hysterectomy. We postulate that more aggressive bladder dissection performed with robot-assistance may be associated with an increased risk of urinary retention when compared to traditional laparoscopic hysterectomy. Early diagnosis and proper management with self catheterization may reduce the morbidity associated with urinary retention.
377
Open Communications 23dOncology (8:00 AM d 8:05 AM)
Robotic Surgery and Endometrial Cancer Staging: What Are the Advantages? McCann C, Whitfield G, Boruta D, del Carmen M, Gooodman A, Schorge J. Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts Study Objective: Review the initial experience with robotic assisted laparoscopy for staging of endometrial cancer at Massachusetts General Hospital. Design: Retrospective review of initial experience with robotic assisted laparoscopy performed for staging of endometrial cancer, comprising all cases from 4/2009-4/2010. Setting: Academic, teaching hospital with gynecologic oncology fellowship program. Patients: Thirty-seven women with endometrial cancer. Intervention: Robotic assisted laparoscopic surgical staging including hysterectomy, salpingo-oophorectomy, and lymph node dissection.
S109
Measurements and Main Results: The mean age at diagnosis was 61 (range: 44-78). The mean BMI was 34 (range: 20-63). Preoperative histology was grade 1 in twenty-six women, grade 2 in four, grade 3 in one, and other in six. Twenty-five (68%) had comprehensive staging including both a pelvic and para-aortic lymph node dissection while twelve (32%) had a pelvic lymph node dissection alone. The mean lymph node counts for both the pelvic and para-aortic dissections were 17 and 11, respectively. The median EBL was 100 ml (range: 25-500). The median length of stay was 1 day (range: 1-46).Eighty-six percent (32/37) were uterine confined (Stage I and II). One woman had positive peritoneal cytology. Lymph node metastases were identified in four women, including two in whom histology was grade 1. Conclusion: The addition of robotic assisted laparoscopy for endometrial cancer staging has allowed us to offer a minimally invasive approach in obese and morbidly obese women that formerly would have undergone laparotomy at our institution. It allows for comprehensive surgical staging while affording shorter hospital stays and minimal blood loss.
378
Open Communications 23dOncology (8:06 AM d 8:11 AM)
Single Incision Total Laparoscopic Hysterectomy: A Review of Our First Seventy-Five Patients McClelland RC,1,2 Lette L.1 1Rock Hill Gyn/Ob Associates, Rock Hill, South Carolina; 2Piedmont Medical Center, Rock Hill, South Carolina Study Objective: To assess the efficacy, safety and patient satisfaction with single incision total laparoscopic hysterectomy. Design: Retrospective analysis of 75 consecutive single incision total laparoscopic hysterectomies performed by the same surgeon (primary author), utilizing the same technique, in the same hospital. Chart review and follow up phone calls were performed for analysis. Setting: Southern suburban obstetrical and gyncological private practice and community hospital. Patients: 75 patients (ages 29-62) scheduled to undergo hysterectomy for benign indications. Intervention: Single incision (2cm umbilical) total laparoscopic hysterectomy performed utilizing the S.I.L.S port (Covidien), 5mm flexible laparoscope (Olympus), 10mm Ligasure (Valley Lab) on the vessels and the Harmonic Hook (Ethicon) for the colpotomy. The cuff was closed with 0 polysorb suture utilizing EndoStitch (Covidien) and secured posteriorly with Lapra Ty (Ethicon). Cystoscopy was performed on all patients. Measurements and Main Results: Of the 75 patients who underwent single incision total laparoscopic hysterectomy: 94% reported being ‘‘extremely satisfied’’, 6% were ‘‘satisfied’’ and 0% were ‘‘unsatisfied’’ with the procedure. 24 hours after surgery (the time of discharge) 80% of patients reported ‘‘none to mild pain’’ (requiring no medication or over the counter medicine), 15% reported ‘‘moderate pain’’ (requiring perscription strength NSAID’s), 5% reported severe pain (requiring narcotics). There was 1 enterotomy upon entry (prior to port placement) that was recognized and repaired and 1 wound seroma. There were no cuff dehisciences, urologic injuries or readmissions. The average patient weight was 85 kilograms (187 pounds); average body mass index was 29. 80% of patients had previous abdominal surgery, 40% had at least 1 previous cesarean section. Conclusion: Single incision total laparoscopic hysterectomy is a safe, effective procedure with minimal to mild postoperative pain and high patient satisfaction. It can be performed safely on patients of various body mass indexes and those with a history of prior abdominal surgery. 379
Open Communications 23dOncology (8:12 AM d 8:17 AM)
Two-Port Access Staging Laparoscopy for Endometrial Cancer: A Pilot Study Paek J, Lee SH, Yim GW, Lee M, Nam EJ, Kim YT, Kim SW. Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
S110
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S109–S127
Study Objective: To introduce a two-port access staging laparoscopy in endometrial cancer and evaluate the feasibility and surgical outcomes of this operation. Design: Prospective cohort study. Setting: A university hospital tertiary referral center. Patients: Analysis of 13 patients who underwent two-port access staging laparoscopy for endometrial cancer. Intervention: A two-port access system consisted of a single multi-channel port at the umbilicus and an ancillary 5-mm port in the suprapubic area. Patient status was estimated in terms of operative morbidity and surgical outcomes. Measurements and Main Results: All operations were completed laparoscopically with no conversion to conventional laparoscopy or laparotomy. Twelve cases of endometrial cancer staging included upper paraaortic lymph node dissection extended to the renal vein level were performed. One patient who had been diagnosed with endocervical cancer before surgery underwent type III radical hysterectomy. Median patient age and body mass index were 54 years and 23.0 kg/m2, respectively. Median operation duration was 240 minutes (range 188 to 360 minutes). Median estimated blood loss was 180 mL. Median number of lymph nodes obtained was 31 (range 17 to 52). Median postoperative hospital stay was 7 days. There were no perioperative complications. Conclusion: Two-port access staging laparoscopy using single multichannel port system could be feasible procedure in selected endometrial cancer patients with only minimal skin incisions.
380
Open Communications 23dOncology (8:18 AM d 8:23 AM)
Robotic Port-Site Metastases in Patients with Gynecological Malignancies Tabah BN,1 Soliman PT,2 Schmeler KM,2 Ramirez PT.2 1Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; 2Department of Gynecologic Oncology, M.D, Anderson Cancer Center, Houston, Texas Study Objective: The aim of this study is to describe the rate of port-site metastases in patients who underwent robotic surgery for a suspected gynecologic malignancy. Design: A prospective database of all patient undergoing robotic procedures by the gynecologic oncology service is maintained. We reviewed all cases performed between December 2006 and March 2010. All patients with a diagnosis of cancer were included. Setting: M.D Anderson Cancer Center. Patients: Two hundred and forty-eight robotic procedures were performed during the study period. Seventy-five percent of the cases had cancer with median age of 55 years and median BMI of 29.4. Intervention: Medical records were reviewed for the presence of port-site metastases defined as tumor recurrence in the abdominal wall, near or within the scar tissue of the previous robotic-trocar site. Measurements and Main Results: Port-site metastases were detected in 2 of 185 patients (1.08%) who underwent a robotic procedure for a suspected gynecologic malignancy. The interval of time between robotic surgery and port-site metastasis was less than 1 month and 11 months. The first patient underwent surgery for an adnexal mass and the final pathology revealed metastatic gallbladder adenocarcinoma. The second patient was diagnosed with a cervical vs. endometrial adenocarcinoma. She underwent neoadjuvant chemoradiation then robotic hysterectomy/BSO. Final pathology was consistent with endometrial cancer. She recurred 11 months postoperatively and was noted to have port-site metastasis at the transumbilical trocar site; as well as carcinomatosis. No port-site metastases developed in patients undergoing primary surgery for cervical, endometrial, or ovarian cancer. Conclusion: The rate of port-site metastases after robotic procedures in women with gynecologic malignancies is low and is similar to the rate documented in the medical literature for laparoscopic procedures.
381
Open Communications 23dOncology (8:24 AM d 8:29 AM)
Endometrial Carcinoma: 178 Patients Treated by Laparoscopy Tejerizo A, Mun˜oz L, Marqueta L, Lorenzo E, Guillen C, Lo´pez G, Alvarez C, Pe´rez C, Mun˜oz JL, Jime´nez JS. Gynecologic Oncology and Endoscopy, Hospital 12 de Octubre, Madrid, Spain Study Objective: To evaluate results and complications of laparoscopic surgery in patients with cancer of endometrium. Design: Descriptive retrospective study. Patients with incomplete data during the picking up or the follow-up as well as those with other synchronic cancers were excluded. Setting: Unit of Gynecologic Oncology and Endoscopy of the Hospital 12 de Octubre. Madrid. Spain. Patients: 178 patients diagnosed of endometrial cancer during the years 2001 to 2007. Intervention: Laparoscopic total extrafascial hysterectomy with bilateral anexectomy. Pelvic lymphadenectomy. Para-aortic lymphadenectomy. Omentectomy. Measurements and Main Results: Mean age was 63 years. Mean age of menopause was 51 years. Mean value of Body Mass Index was 30. 18 patients had previous treatment with tamoxifen for breast cancer. Mean value of the pre-surgical Ca125 was 31 UI/ml. 18% of the patients had any previous abdominal surgical procedure. Distribution for stages: IA=70,2%, IB=20,8%, IIA=1,7%, IIB=1,1%, IIIA=2,2%, IIIB=0%, IIIC=3,9% and IV=0 %. 51% of tumors were high differentiated, 27% moderate and 22% poorly. 88% of them corresponded to endometrial adenocarcinomas. Lymphadenectomy was practiced to the 58% of the patients. In 48% of the cases uterus was sent to intraoperatory study. Mean pre-surgical hemoglobine was 13.4gr/dl and post-surgical 11.3gr/dl. Ten patients (7,5 %) required blood transfusion. The mean duration of the procedure was 173 minutes (range 60-360 minutes). Intraoperatory complications were: significant hemorrhage in three patients, uterine perforation in three patients and difficulty for the uterine extraction in two cases because of myomas. 3,8% of the cases were reconverted into laparotomy. Postoperative complications were: Fever, haematoma of abdominal wall, paralytic ileus and re-intervention. The mean hospitalization was 5 days (range 2-24). Conclusion: The laparoscopic approach is adequate in the treatment of the cancer of endometrium, with the same level of radicality than laparotomy, and with a fall rate of complications.
382
Open Communications 23dOncology (8:30 AM d 8:35 AM)
Robotic Surgical Staging for Obese Patients with Endometrial Cancer Tang KY,1 Winter W,2 Gardiner S.1 1Legacy Health System, Portland, Oregon; 2Northwest Cancer Specialists, Portland, Oregon Study Objective: To compare surgical outcomes, particularly lymph node yields, for robotic staging compared with laparotomy in obese endometrial cancer patients. Design: Retrospective cohort study. Setting: Community gynecologic oncology practice in Portland, OR. Patients: Obese (BMI >30) endometrial cancer patients undergoing surgical staging from 2006-2009. Intervention: Robotic or open surgical staging. Measurements and Main Results: Data has been obtained for 172 patients to date (115 robotic, 57 laparotomy). Mean BMI was 39.7 and 39.5 respectively, and there was no difference between groups in terms of age, comorbidities, or grade/stage of disease. Conversion rate among robotic patients was 10.4%. The mean number of pelvic nodes (10.8 vs 7.9, p=0.026) and total pelvic plus para-aortic nodes (13.1 vs 9.4, p=0.020) were significantly higher for the robotic group. Among patients with grade 2 or 3 disease only, the mean number of pelvic (13.1 vs 7.7, p\0.001), para-aortic (3.1 vs 1.1, p=0.018), and total lymph nodes (16.2 vs 7.5, p\0.001) were all significantly higher in the robotic group. The mean total surgical time was significantly longer in the robotic group
Open Communications 22dRobotics (8:54 AM d 8:59 AM)
Urinary Retention: Is It a Common Complication of Robot Assisted Laparoscopic Hysterectomy? Smorgick-Rosenbaum N, Patzkowsky K, Hassouneh S, Song A, Advincula A, As-Sanie S. Obstetrics and Gynecology, University of Michigan Health System, Ann Arbor, Michigan Study Objective: To investigate the occurrence of urinary retention following laparoscopic hysterectomy by traditional laparoscopic approach and robot-assisted approach. Design: IRB-approved retrospective chart review. Setting: A university hospital tertiary referral center. Patients: All patients who underwent laparoscopic hysterectomy via a traditional laparoscopic approach (N=242) and a robotic-assisted approach (n=248) from 3/2000 until 12/2009 for benign indications at the University of Michigan Health System. Urinary retention was defined as an inability to spontaneously void following removal of the Foley catheter on post-operative day 1, and requiring either self catheterization or Foley replacement. Intervention: Laparoscopic or robot-assisted total/supracervical hysterectomy. Measurements and Main Results: Urinary retention occurred in 36/490 (7.4%) women. There were no statistically significant differences between women who developed urinary retention compared with those who did not in terms of age, BMI, presence of diabetes, smoking status, number of previous abdominal surgeries, and number of prior cesarean sections. Regarding the surgical characteristics, urinary retention was more common among women who underwent a robotassisted hysterectomy compared with traditional laparoscopic hysterectomy [25 (10.1%) cases versus 11 (4.5%) cases, p=.02]. Other surgical characteristics such as uterine weight, severe adhesions, total versus supracervical hysterectomy and presence of endometriosis were similar in women who developed urinary retention compared with those who did not. The main complication from urinary retention was lower urinary tract infection, occurring in 5/36 (13.9%) cases. However, none of these women developed pyelonephritis, and none required readmission. Conclusion: Urinary retention appears to be a relatively common complication of robot-assisted hysterectomy. We postulate that more aggressive bladder dissection performed with robot-assistance may be associated with an increased risk of urinary retention when compared to traditional laparoscopic hysterectomy. Early diagnosis and proper management with self catheterization may reduce the morbidity associated with urinary retention.
377
Open Communications 23dOncology (8:00 AM d 8:05 AM)
Robotic Surgery and Endometrial Cancer Staging: What Are the Advantages? McCann C, Whitfield G, Boruta D, del Carmen M, Gooodman A, Schorge J. Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts Study Objective: Review the initial experience with robotic assisted laparoscopy for staging of endometrial cancer at Massachusetts General Hospital. Design: Retrospective review of initial experience with robotic assisted laparoscopy performed for staging of endometrial cancer, comprising all cases from 4/2009-4/2010. Setting: Academic, teaching hospital with gynecologic oncology fellowship program. Patients: Thirty-seven women with endometrial cancer. Intervention: Robotic assisted laparoscopic surgical staging including hysterectomy, salpingo-oophorectomy, and lymph node dissection.
S109
Measurements and Main Results: The mean age at diagnosis was 61 (range: 44-78). The mean BMI was 34 (range: 20-63). Preoperative histology was grade 1 in twenty-six women, grade 2 in four, grade 3 in one, and other in six. Twenty-five (68%) had comprehensive staging including both a pelvic and para-aortic lymph node dissection while twelve (32%) had a pelvic lymph node dissection alone. The mean lymph node counts for both the pelvic and para-aortic dissections were 17 and 11, respectively. The median EBL was 100 ml (range: 25-500). The median length of stay was 1 day (range: 1-46).Eighty-six percent (32/37) were uterine confined (Stage I and II). One woman had positive peritoneal cytology. Lymph node metastases were identified in four women, including two in whom histology was grade 1. Conclusion: The addition of robotic assisted laparoscopy for endometrial cancer staging has allowed us to offer a minimally invasive approach in obese and morbidly obese women that formerly would have undergone laparotomy at our institution. It allows for comprehensive surgical staging while affording shorter hospital stays and minimal blood loss.
378
Open Communications 23dOncology (8:06 AM d 8:11 AM)
Single Incision Total Laparoscopic Hysterectomy: A Review of Our First Seventy-Five Patients McClelland RC,1,2 Lette L.1 1Rock Hill Gyn/Ob Associates, Rock Hill, South Carolina; 2Piedmont Medical Center, Rock Hill, South Carolina Study Objective: To assess the efficacy, safety and patient satisfaction with single incision total laparoscopic hysterectomy. Design: Retrospective analysis of 75 consecutive single incision total laparoscopic hysterectomies performed by the same surgeon (primary author), utilizing the same technique, in the same hospital. Chart review and follow up phone calls were performed for analysis. Setting: Southern suburban obstetrical and gyncological private practice and community hospital. Patients: 75 patients (ages 29-62) scheduled to undergo hysterectomy for benign indications. Intervention: Single incision (2cm umbilical) total laparoscopic hysterectomy performed utilizing the S.I.L.S port (Covidien), 5mm flexible laparoscope (Olympus), 10mm Ligasure (Valley Lab) on the vessels and the Harmonic Hook (Ethicon) for the colpotomy. The cuff was closed with 0 polysorb suture utilizing EndoStitch (Covidien) and secured posteriorly with Lapra Ty (Ethicon). Cystoscopy was performed on all patients. Measurements and Main Results: Of the 75 patients who underwent single incision total laparoscopic hysterectomy: 94% reported being ‘‘extremely satisfied’’, 6% were ‘‘satisfied’’ and 0% were ‘‘unsatisfied’’ with the procedure. 24 hours after surgery (the time of discharge) 80% of patients reported ‘‘none to mild pain’’ (requiring no medication or over the counter medicine), 15% reported ‘‘moderate pain’’ (requiring perscription strength NSAID’s), 5% reported severe pain (requiring narcotics). There was 1 enterotomy upon entry (prior to port placement) that was recognized and repaired and 1 wound seroma. There were no cuff dehisciences, urologic injuries or readmissions. The average patient weight was 85 kilograms (187 pounds); average body mass index was 29. 80% of patients had previous abdominal surgery, 40% had at least 1 previous cesarean section. Conclusion: Single incision total laparoscopic hysterectomy is a safe, effective procedure with minimal to mild postoperative pain and high patient satisfaction. It can be performed safely on patients of various body mass indexes and those with a history of prior abdominal surgery. 379
Open Communications 23dOncology (8:12 AM d 8:17 AM)
Two-Port Access Staging Laparoscopy for Endometrial Cancer: A Pilot Study Paek J, Lee SH, Yim GW, Lee M, Nam EJ, Kim YT, Kim SW. Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
S110
Abstracts / Journal of Minimally Invasive Gynecology 17 (2010) S109–S127
Study Objective: To introduce a two-port access staging laparoscopy in endometrial cancer and evaluate the feasibility and surgical outcomes of this operation. Design: Prospective cohort study. Setting: A university hospital tertiary referral center. Patients: Analysis of 13 patients who underwent two-port access staging laparoscopy for endometrial cancer. Intervention: A two-port access system consisted of a single multi-channel port at the umbilicus and an ancillary 5-mm port in the suprapubic area. Patient status was estimated in terms of operative morbidity and surgical outcomes. Measurements and Main Results: All operations were completed laparoscopically with no conversion to conventional laparoscopy or laparotomy. Twelve cases of endometrial cancer staging included upper paraaortic lymph node dissection extended to the renal vein level were performed. One patient who had been diagnosed with endocervical cancer before surgery underwent type III radical hysterectomy. Median patient age and body mass index were 54 years and 23.0 kg/m2, respectively. Median operation duration was 240 minutes (range 188 to 360 minutes). Median estimated blood loss was 180 mL. Median number of lymph nodes obtained was 31 (range 17 to 52). Median postoperative hospital stay was 7 days. There were no perioperative complications. Conclusion: Two-port access staging laparoscopy using single multichannel port system could be feasible procedure in selected endometrial cancer patients with only minimal skin incisions.
380
Open Communications 23dOncology (8:18 AM d 8:23 AM)
Robotic Port-Site Metastases in Patients with Gynecological Malignancies Tabah BN,1 Soliman PT,2 Schmeler KM,2 Ramirez PT.2 1Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; 2Department of Gynecologic Oncology, M.D, Anderson Cancer Center, Houston, Texas Study Objective: The aim of this study is to describe the rate of port-site metastases in patients who underwent robotic surgery for a suspected gynecologic malignancy. Design: A prospective database of all patient undergoing robotic procedures by the gynecologic oncology service is maintained. We reviewed all cases performed between December 2006 and March 2010. All patients with a diagnosis of cancer were included. Setting: M.D Anderson Cancer Center. Patients: Two hundred and forty-eight robotic procedures were performed during the study period. Seventy-five percent of the cases had cancer with median age of 55 years and median BMI of 29.4. Intervention: Medical records were reviewed for the presence of port-site metastases defined as tumor recurrence in the abdominal wall, near or within the scar tissue of the previous robotic-trocar site. Measurements and Main Results: Port-site metastases were detected in 2 of 185 patients (1.08%) who underwent a robotic procedure for a suspected gynecologic malignancy. The interval of time between robotic surgery and port-site metastasis was less than 1 month and 11 months. The first patient underwent surgery for an adnexal mass and the final pathology revealed metastatic gallbladder adenocarcinoma. The second patient was diagnosed with a cervical vs. endometrial adenocarcinoma. She underwent neoadjuvant chemoradiation then robotic hysterectomy/BSO. Final pathology was consistent with endometrial cancer. She recurred 11 months postoperatively and was noted to have port-site metastasis at the transumbilical trocar site; as well as carcinomatosis. No port-site metastases developed in patients undergoing primary surgery for cervical, endometrial, or ovarian cancer. Conclusion: The rate of port-site metastases after robotic procedures in women with gynecologic malignancies is low and is similar to the rate documented in the medical literature for laparoscopic procedures.
381
Open Communications 23dOncology (8:24 AM d 8:29 AM)
Endometrial Carcinoma: 178 Patients Treated by Laparoscopy Tejerizo A, Mun˜oz L, Marqueta L, Lorenzo E, Guillen C, Lo´pez G, Alvarez C, Pe´rez C, Mun˜oz JL, Jime´nez JS. Gynecologic Oncology and Endoscopy, Hospital 12 de Octubre, Madrid, Spain Study Objective: To evaluate results and complications of laparoscopic surgery in patients with cancer of endometrium. Design: Descriptive retrospective study. Patients with incomplete data during the picking up or the follow-up as well as those with other synchronic cancers were excluded. Setting: Unit of Gynecologic Oncology and Endoscopy of the Hospital 12 de Octubre. Madrid. Spain. Patients: 178 patients diagnosed of endometrial cancer during the years 2001 to 2007. Intervention: Laparoscopic total extrafascial hysterectomy with bilateral anexectomy. Pelvic lymphadenectomy. Para-aortic lymphadenectomy. Omentectomy. Measurements and Main Results: Mean age was 63 years. Mean age of menopause was 51 years. Mean value of Body Mass Index was 30. 18 patients had previous treatment with tamoxifen for breast cancer. Mean value of the pre-surgical Ca125 was 31 UI/ml. 18% of the patients had any previous abdominal surgical procedure. Distribution for stages: IA=70,2%, IB=20,8%, IIA=1,7%, IIB=1,1%, IIIA=2,2%, IIIB=0%, IIIC=3,9% and IV=0 %. 51% of tumors were high differentiated, 27% moderate and 22% poorly. 88% of them corresponded to endometrial adenocarcinomas. Lymphadenectomy was practiced to the 58% of the patients. In 48% of the cases uterus was sent to intraoperatory study. Mean pre-surgical hemoglobine was 13.4gr/dl and post-surgical 11.3gr/dl. Ten patients (7,5 %) required blood transfusion. The mean duration of the procedure was 173 minutes (range 60-360 minutes). Intraoperatory complications were: significant hemorrhage in three patients, uterine perforation in three patients and difficulty for the uterine extraction in two cases because of myomas. 3,8% of the cases were reconverted into laparotomy. Postoperative complications were: Fever, haematoma of abdominal wall, paralytic ileus and re-intervention. The mean hospitalization was 5 days (range 2-24). Conclusion: The laparoscopic approach is adequate in the treatment of the cancer of endometrium, with the same level of radicality than laparotomy, and with a fall rate of complications.
382
Open Communications 23dOncology (8:30 AM d 8:35 AM)
Robotic Surgical Staging for Obese Patients with Endometrial Cancer Tang KY,1 Winter W,2 Gardiner S.1 1Legacy Health System, Portland, Oregon; 2Northwest Cancer Specialists, Portland, Oregon Study Objective: To compare surgical outcomes, particularly lymph node yields, for robotic staging compared with laparotomy in obese endometrial cancer patients. Design: Retrospective cohort study. Setting: Community gynecologic oncology practice in Portland, OR. Patients: Obese (BMI >30) endometrial cancer patients undergoing surgical staging from 2006-2009. Intervention: Robotic or open surgical staging. Measurements and Main Results: Data has been obtained for 172 patients to date (115 robotic, 57 laparotomy). Mean BMI was 39.7 and 39.5 respectively, and there was no difference between groups in terms of age, comorbidities, or grade/stage of disease. Conversion rate among robotic patients was 10.4%. The mean number of pelvic nodes (10.8 vs 7.9, p=0.026) and total pelvic plus para-aortic nodes (13.1 vs 9.4, p=0.020) were significantly higher for the robotic group. Among patients with grade 2 or 3 disease only, the mean number of pelvic (13.1 vs 7.7, p\0.001), para-aortic (3.1 vs 1.1, p=0.018), and total lymph nodes (16.2 vs 7.5, p\0.001) were all significantly higher in the robotic group. The mean total surgical time was significantly longer in the robotic group