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Zhou J, Zhang R, Tang X, Liu S, Jiang X. Urinary retention between nerve-sparing radical hysterectomy and radical hysterectomy for cervical cancer: A meta-analysis. Medicine (Baltimore) 2023; 102:e32985. [PMID: 36862911 PMCID: PMC9981420 DOI: 10.1097/md.0000000000032985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
This study intended to assess the urinary retention between nerve-sparing radical hysterectomy and radical hysterectomy in cervical cancer. Relevant studies were selected from databases of PubMed, Embase, Wanfang, and China National Knowledge Internet with the last report up to January 15, 2022. Hazard ratio (HR) and 95% confidence interval (CI) were chosen as the evaluation index. Heterogeneity was assessed using Cochran Q test and I2 test. Subgroup analysis was conducted based on areas and cancer types (primary and metastatic cancer). A total of 8 articles (retrospective cohort studies) were selected in the meta-analysis. There were significant correlations between nerve-sparing radical hysterectomy and radical hysterectomy in related with urinary retention (HR [95% CI] = 1.78 [1.37, 2.31], P < .001) and (HR [95% CI] = 2.49 [1.43, 4.33], P = .001) of cervical cancer patients. Egger test revealed a significant publication bias (P = .014). Sensitivity analysis via omitting 1 study at each time showed that omission of any study made significant difference (P < .05), indicating reliability and good stability for the analysis. Additionally, there were significant heterogeneities in most subgroups.
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Affiliation(s)
- Jing Zhou
- Department of Obstetrics and Gynecology, Daping Hospital, Army Military Medical University, Chongqing, China
| | - Rong Zhang
- Department of Obstetrics and Gynecology, Daping Hospital, Army Military Medical University, Chongqing, China
| | - Xiaohui Tang
- Department of Obstetrics and Gynecology, Daping Hospital, Army Military Medical University, Chongqing, China
| | - Suwei Liu
- Department of Obstetrics and Gynecology, Daping Hospital, Army Military Medical University, Chongqing, China
| | - Xiajuan Jiang
- Department of Obstetrics and Gynecology, Daping Hospital, Army Military Medical University, Chongqing, China
- * Correspondence: Xiajuan Jiang, Department of Obstetrics and Gynecology, Daping Hospital, Army Military Medical University, Chongqing, China (e-mail address: )
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Chen L, Liu LP, Wen N, Qiao X, Meng YG. Comparative analysis of robotic vs laparoscopic radical hysterectomy for cervical cancer. World J Clin Cases 2019; 7:3185-3193. [PMID: 31667168 PMCID: PMC6819296 DOI: 10.12998/wjcc.v7.i20.3185] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/24/2019] [Accepted: 09/09/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cervical cancer is the most common gynecological malignancy, ranking first in female reproductive malignancies with more than 500000 new cases and 275000 deaths each year. Traditionally, open radical hysterectomy is considered the standard surgical procedure for the treatment of resectable cervical cancer. The latest guidelines from the National Comprehensive Cancer Network and the European Society of Gynecological Oncology suggest that open surgery and laparoscopic surgery (using traditional laparoscopic or robotic techniques) are the main surgical approaches for radical hysterectomy for patients with stage IA2-IIA cervical cancer. Robotic surgery has been increasingly used in abdominal surgery and has shown more beneficial effects.
AIM To analyse the perioperative conditions, complications, and short-term and long-term effects in patients undergoing robotic radical hysterectomy (RRH) and laparoscopic radical hysterectomy (LRH) to compare their clinical efficacy, safety, and feasibility.
METHODS The perioperative data of patients undergoing RRH and LRH were extracted and collected from the database of surgical treatments for cervical cancer for statistical analysis.
RESULTS Of the patients, 342 underwent LRH for cervical cancer, and 216 underwent RRH. The total complication rate was 9.65% (20 patients) in the RRH group and 17.59% (60 patients) in the LRH group. The complication rate was significantly lower in the RRH group than in the LRH group. There was no significant difference in the follow-up period (P = 0.658). The total recurrence rates were 15.7% and 12% in the RRH and LRH groups, respectively. The progression-free survival time was 28.91 ± 15.68 mo and 28.34 ± 15.13 mo in the RRH and LRH groups, respectively (P = 0.669). The overall survival (OS) rates were 92.13% and 94.45% in the RRH and LRH groups, respectively (P = 0.292). The OS time was 29.87 ± 15.92 mo and 29.41 ± 15.14 mo in the RRH and LRH groups, respectively (P = 0.732). The survival curves and the progression-free survival curves were not statistically significantly different between the two groups (P = 0.407 and 0.28, respectively).
CONCLUSION RRH is associated with significantly less operative time and blood loss than LRH. The two procedures have similar complication rates, OS, and progression-free survival time.
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Affiliation(s)
- Li Chen
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing 100853, China
| | - Li-Ping Liu
- Department of Obstetrics and Gynecology, The First Central Hospital of Baoding, Baoding 071000, Hebei Province, China
| | - Na Wen
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiao Qiao
- Medical Big Data Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Yuan-Guang Meng
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing 100853, China
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Ding D, Jiang H, Nie J, Liu X, Guo SW. Concurrent Learning Curves of 3-Dimensional and Robotic-Assisted Laparoscopic Radical Hysterectomy for Early-Stage Cervical Cancer Using 2-Dimensional Laparoscopic Radical Hysterectomy as a Benchmark: A Single Surgeon's Experience. Med Sci Monit 2019; 25:5903-5919. [PMID: 31392971 PMCID: PMC6698092 DOI: 10.12659/msm.914952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background For early-stage cervical cancers, radical hysterectomy (RH) with pelvic lymphadenectomy has been the standard care. This study compared the learning curves and intra-, peri-, and post-operative outcomes for 3-dimensional laparoscopic RH (3D-LRH) and robotic-assisted (RA)-LRH by a surgeon highly skilled in 2-dimensional (2D)-LRH for treatment of early-stage cervical cancer. Material/Methods Two hundred and thirty-nine patients with early-stage cervical cancer (FIGO stage: Ia2–IIa2) admitted to Shanghai Obstetrics and Gynecology Hospital, Fudan University were recruited into this prospective study: 54, 85, and 100 patients underwent 2D-, 3D-, and RA-LRH, respectively and were followed up. Patients’ demographic, clinical, and operative information was retrieved and compared. CUSUM (cumulative summation) analysis using a benchmark derived from previously performed 2D-LRHs. Results Both 3D- and RA-LRH had a steep learning curve. 3D-LRH was superior to 2D- and RA-LRH in terms of significantly shorter operating time. For all approaches, the operating time was associated with the uterus size of the patient and was not affected by other parameters. All approaches of LRH yielded comparable radicality and operative results other than operative time. Conclusions Both 3D- and RA-LRH approaches had similar radicality, and intra-operative and post-operative complication rates, however, 3D-LRH had the shortest operating time and lowest amount of blood loss. After reaching proficiency, RA-LRH had comparable operating time with that of 2D-LRH, and might be even shorter in cases where surgeon has acquired more experience. In countries where labor costs are low; 3D-LRH might be preferable to 2D- and RA-LRH for early-stage cervical cancer.
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Affiliation(s)
- Ding Ding
- Department of Gynecology, Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (mainland)
| | - Hongyuan Jiang
- Department of Gynecology, Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (mainland)
| | - Jichan Nie
- Department of Gynecology, Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (mainland)
| | - Xishi Liu
- Department of Gynecology, Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (mainland).,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China (mainland)
| | - Sun-Wei Guo
- Department of Gynecology, Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China (mainland).,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China (mainland)
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Lim TYK, Lin KKM, Wong WL, Aggarwal IM, Yam PKL. Surgical and Oncological Outcome of Total Laparoscopic Radical Hysterectomy versus Radical Abdominal Hysterectomy in Early Cervical Cancer in Singapore. Gynecol Minim Invasive Ther 2019; 8:53-58. [PMID: 31143623 PMCID: PMC6515754 DOI: 10.4103/gmit.gmit_43_18] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 01/17/2019] [Accepted: 02/25/2019] [Indexed: 11/07/2022] Open
Abstract
Introduction: The Wertheim's radical abdominal hysterectomy (RAH) has been the traditional surgical approach for operable Stage IB cervical cancer in Singapore whereas total laparoscopic radical hysterectomy (TLRH) was introduced only in 2009. In this study, we aimed to compare the long-term surgical outcome between the two routes of surgery in our center. Methods: This is a prospective study performed in a single large tertiary institution in Singapore. Inclusion criteria included surgically fit patients with early cervical cancer and no radiological evidence of regional or distant metastases. Results: From November 2009 to December 2014, 51 TLRHs and 85 RAHs were performed. Median blood loss in the TLRH group was significantly lower than in the RAH group (300 vs. 500 mL; P = 0.002) as was median hospital stay (5 vs. 6 days; P = 0.001). Operative time was significantly higher in the TLRH group (262 vs. 228 min; P < 0.001). There was no significant difference in bladder recovery. Intraoperative complications were encountered in 2 (3.9%) TLRH patients and 1 (1.2%) RAH patient. Postoperative complications occurred in 3 (5.9%) TLRH patients and 8 (9.4%) RAH patients. With a median follow-up of 117 (range 1.6–314.6) weeks in the TLRH group and 143.3 (range 0.4–304.7) weeks in the RAH group, 9 (17.6%) TLRH patients and 7 (8.2%) RAH patients had recurrence. There was no significant difference in the overall 3-year survival between the TLRH group and the RAH group for tumor size ≤2 cm (100.0% vs. 97.0%; P = 0.37). However, there was a trend toward lower survival for the TLRH group for tumor size >2 cm (61.9% vs. 85.4%; P = 0.06). Conclusion: The results of our study suggest that with appropriate patient selection, TLRH can be a safe and effective procedure for the management of early cervical cancer in Singapore, especially in women with small tumors ≤2 cm but should be used with caution in women with larger tumors.
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Affiliation(s)
| | - Krystal Koh Miao Lin
- Department of Obstetrics & Gynecology, KK Women's and Children's Hospital, Singapore
| | - Wai Loong Wong
- Department of Gynaecologic Oncology, KK Women's and Children's Hospital, Singapore
| | - Ieera Madan Aggarwal
- Department of Gynaecologic Oncology, KK Women's and Children's Hospital, Singapore
| | - Philip Kwai Lam Yam
- Department of Gynaecologic Oncology, KK Women's and Children's Hospital, Singapore
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Matanes E, Abitbol J, Kessous R, Kogan L, Octeau D, Lau S, Salvador S, Gotlieb WH. Oncologic and Surgical Outcomes of Robotic Versus Open Radical Hysterectomy for Cervical Cancer. J Obstet Gynaecol Can 2018; 41:450-458. [PMID: 30529223 DOI: 10.1016/j.jogc.2018.09.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/14/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE In view of the recent controversy concerning the use of minimally invasive radical hysterectomy as primary treatment for early stage cervical cancer, this study compared the survival and perioperative outcomes in a cohort of patients who underwent radical hysterectomy either by laparotomy or by robotics. METHODS This retrospective study compared all consecutive patients with early stage cervical cancer since the beginning of the Division of Gynecologic Oncology at the Jewish General Hospital in 2003, who underwent robotic radical hysterectomy (n = 74) with a cohort of all consecutive patients from the immediate past who underwent open radical hysterectomy (n = 24) for early stage cervical cancer. All patients were treated at the Jewish General Hospital in Montréal (Canadian Task Force Classification II-2). RESULTS The median follow-up time for the robotic group was 46 months. During that time, 7% and 17% of patients in the robotic group and the laparotomy group had disease recurrence, respectively (P = 0.12). Cox multivariate regression showed no statistically significant effect of surgical approach on overall survival (hazard ratio 1.50, P = 0.63) or on progression-free survival (hazard ratio 0.29, P = 0.07). Patients in the robotic cohort had significantly shorter median hospital stays (1 day vs. 7 days, P < 0.001), and their overall incidence of postoperative complications was lower (13% vs. 50%, P < 0.001). Median estimated blood loss for robotics was also significantly lower (82 mL vs. 528 mL, P < 0.001). CONCLUSION Based on the data on a limited number of patients in a Canadian context, robotic radical hysterectomy did not lead to worse oncologic outcomes and was associated with improved short-term surgical outcomes. One might consider the evaluation of more personalized surgical decision making.
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Affiliation(s)
- Emad Matanes
- Division of Gynecologic Oncology, Segal Cancer Centre, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Montreal, QC
| | - Jeremie Abitbol
- Division of Gynecologic Oncology, Segal Cancer Centre, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Montreal, QC
| | - Roy Kessous
- Division of Gynecologic Oncology, Segal Cancer Centre, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Montreal, QC
| | - Liron Kogan
- Division of Gynecologic Oncology, Segal Cancer Centre, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Montreal, QC
| | - David Octeau
- Division of Gynecologic Oncology, Segal Cancer Centre, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Montreal, QC
| | - Susie Lau
- Division of Gynecologic Oncology, Segal Cancer Centre, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Montreal, QC
| | - Shannon Salvador
- Division of Gynecologic Oncology, Segal Cancer Centre, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Montreal, QC
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Segal Cancer Centre, Lady Davis Institute of Research, Jewish General Hospital, McGill University, Montreal, QC.
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Lee B, Kim K, Park Y, Lim MC, Bristow RE. Impact of hospital care volume on clinical outcomes of laparoscopic radical hysterectomy for cervical cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e13445. [PMID: 30544427 PMCID: PMC6310549 DOI: 10.1097/md.0000000000013445] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In cervical cancer, the impact of hospital volume of laparoscopic radical hysterectomy (LRH) has not been investigated systematically as in ovarian cancer.The aim of this study was to investigate the impact of hospital care volume of LRH on treatment outcomes of patients with cervical cancer. METHODS The PubMed, Embase, and Cochrane Library databases were searched with the terms "cervical cancer," "radical hysterectomy," and "laparoscopy." The selection criteria included studies presenting operative outcomes and/or perioperative complications of LRH from high-volume hospitals (HVHs) (≥15 cases/year) and low-volume hospitals (LVHs) (<15 cases/year). Fifty-nine studies including 4367 cases were selected. Linear regression analysis weighted by the average annual case number in each study was performed to evaluate differences between the groups. RESULTS In HVH, a higher number of lymph nodes (24.5 vs 21.1; P = .037) were retrieved by LRH in older women (48.4 vs 44.5 years; P = .010) with tendencies of shorter operation time (224.4 vs 256.4 minutes; P = .096) and less blood loss (253.1 vs 322.2 mL; P = .080). Compared with LVH, HVH had fewer patients with stage IA disease (13.8 vs 24.4%; P = .003) and more patients with stage IIA disease (15.3 vs 7.1%; P = .052) with comparable 5-year overall survival (93.1 vs 88.6%; P = .112). CONCLUSION HVH is a prognostic factor for operative outcome and perioperative complications in patients with cervical cancer undergoing LRH. The exact effect of hospital volume on survival outcome needs to be evaluated.
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Affiliation(s)
- Banghyun Lee
- Department of Obstetrics and Gynecology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul
| | - Kidong Kim
- Department of Obstetrics and Gynecology Gyeonggi-do
| | - Youngmi Park
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-Si
| | - Myong Cheol Lim
- Cancer Healthcare Research Branch, Center for Uterine Cancer, and Center for Clinical Trials, Research Institute and Hospital, Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si Gyeonggi-do, Republic of Korea
| | - Robert E. Bristow
- Division of Gynecologic Oncology, Obstetrics and Gynecology, Irvine Medical Center, University of California, Orange, CA
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Misirlioglu S, Turkgeldi E, Boza A, Oktem O, Ata B, Urman B, Taskiran C. The Clinical Utility of a Pulsed Bipolar System and Its Electrosurgical Device During Total Laparoscopic Hysterectomy. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2016.0107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Selim Misirlioglu
- Department of Obstetrics and Gynecology, VKF Koc University Hospital, Istanbul, Turkey
| | - Engin Turkgeldi
- Department of Obstetrics and Gynecology, VKF Koc University Hospital, Istanbul, Turkey
| | - Aysen Boza
- Women's Health Center, VKF Koc University Hospital, Istanbul, Turkey
| | - Ozgur Oktem
- Department of Obstetrics and Gynecology, VKF Koc University School of Medicine, Istanbul, Turkey
| | - Baris Ata
- Department of Obstetrics and Gynecology, VKF Koc University School of Medicine, Istanbul, Turkey
| | - Bulent Urman
- Women's Health Center, VKF Koc University Hospital, Istanbul, Turkey
- Department of Obstetrics and Gynecology, VKF Koc University School of Medicine, Istanbul, Turkey
| | - Cagatay Taskiran
- Women's Health Center, VKF Koc University Hospital, Istanbul, Turkey
- Department of Obstetrics and Gynecology, VKF Koc University School of Medicine, Istanbul, Turkey
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Yang Z, Xiao X. Effect of acupuncture plus medium-frequency electric stimulation on bladder function after radical hysterectomy for cervical cancer. J Acupunct Tuina Sci 2017; 15:371-6. [DOI: 10.1007/s11726-017-1030-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sert BM, Boggess JF, Ahmad S, Jackson AL, Stavitzski NM, Dahl AA, Holloway RW. Robot-assisted versus open radical hysterectomy: A multi-institutional experience for early-stage cervical cancer. Eur J Surg Oncol 2016; 42:513-22. [PMID: 26843445 DOI: 10.1016/j.ejso.2015.12.014] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/11/2015] [Accepted: 12/01/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To compare perioperative and clinico-pathological outcomes of patients with early-stage cervical cancer who underwent robot-assisted radical hysterectomy (RRH) and open radical hysterectomy (ORH). METHODS This retrospective multi-center study abstracted demographic, clinico-pathological and perioperative outcomes data from medical records of 491 cervical cancer patients treated with RRH (n = 259) ORH (n = 232) between 2005 and 2011 at two American and one Norwegian University Cancer Centres. RESULTS Mean estimated blood loss (EBL) and transfusion rates were less for RRH than for ORH (97 vs. 49 mL, p < 0.001, and 3% vs. 7%, p = 0.018, respectively). Mean length of hospital stay (LOS) was significantly shorter in RRH versus ORH (1.8 vs. 5.1 days, p < 0.001). Mean operative time was longer for RRH than ORH (220 vs. 156 min, p < 0.001). Although overall complications were similar (p = 0.49), intra-operative complications were less common in the RRH group than ORH (4% vs. 10%, p = 0.004). In multivariate regression analyses longer operative time, less EBL and intra-operative complications, shorter LOS, and more pre-operative cone were significantly associated with RRH versus ORH. Recurrence and death rates were not statistically different for the two groups at a mean follow-up time of 39 months (p = 1.00 and p = 0.48, respectively). CONCLUSIONS RRH had improved clinical outcomes compared to ORH in the treatment of early-stage cervical cancer in terms of EBL, intra-operative complications, transfusion rates, LOS, and pre-operative cone. Disease recurrence and survival were comparable for the two procedures.
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Affiliation(s)
- B M Sert
- Department of Gynecological Oncology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway.
| | - J F Boggess
- Department of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - S Ahmad
- Department of Gynecologic Oncology, Florida Hospital Cancer Institute, Orlando, FL, USA
| | - A L Jackson
- Department of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC, USA; Division of Gynecological Oncology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - N M Stavitzski
- Department of Gynecologic Oncology, Florida Hospital Cancer Institute, Orlando, FL, USA
| | - A A Dahl
- National Advisory Unit for Late Effects after Cancer Treatment, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - R W Holloway
- Department of Gynecologic Oncology, Florida Hospital Cancer Institute, Orlando, FL, USA
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Abstract
IMPORTANCE Surgery has evolved into the standard therapy for nonbulky carcinoma of the cervix. The mainstay of surgical management is radical hysterectomy; however, less radical procedures have a small but important role in the management of cervical tumors. OBJECTIVE Our objective was to discuss the literature behind the different procedures utilized in the management of cervical cancer, emphasizing the radical hysterectomy. In addition, we aimed to discuss ongoing trials looking at the utility of less radical surgeries as well as emerging technologies in the management of this disease. EVIDENCE ACQUISITION We performed a PubMed literature search for articles in the English language that pertained to the topic of surgical techniques and their outcomes in the treatment of cervical cancer. RESULTS The minimally invasive approaches to radical hysterectomy appear to reduce morbidity without affecting oncological outcomes, although further data are needed looking at long-term outcomes with the robotic platform. Trials are currently ongoing looking at the role of less radical surgery for patients with low-risk disease and the feasibility of sentinel lymph node mapping. CONCLUSIONS AND RELEVANCE Radical hysterectomy with pelvic lymphadenectomy has evolved into the standard therapy for nonbulky disease, and there is a clear advantage in the use of minimally invasive techniques to perform these procedures. However, pending ongoing trials, less radical surgery in patients with low-risk invasive disease as well as sentinel lymph node mapping may emerge as standards of care in selected patients with cervical carcinoma.
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Fagotti A, Vizzielli G, Fanfani F, Gallotta V, Rossitto C, Costantini B, Gueli-Alletti S, Avenia N, Iodice R, Scambia G. Randomized study comparing use of THUNDERBEAT technology vs standard electrosurgery during laparoscopic radical hysterectomy and pelvic lymphadenectomy for gynecologic cancer. J Minim Invasive Gynecol 2013; 21:447-53. [PMID: 24325899 DOI: 10.1016/j.jmig.2013.12.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/01/2013] [Accepted: 12/02/2013] [Indexed: 01/05/2023]
Abstract
STUDY OBJECTIVE To compare operative time with use of THUNDERBEAT (TB) vs standard electrosurgery (SES) during laparoscopic radical hysterectomy and pelvic lymphadenectomy to treat gynecologic tumors. DESIGN Evidence obtained from a properly designed, randomized, controlled trial (Canadian Task Force classification I). SETTING Gynecologic Oncology Unit of the Catholic University of the Sacred Heart in Rome, Italy. PATIENTS Fifty patients with early cervical cancer (FIGO stages IA2, IB1, IIA <2 cm) or locally advanced cervical cancer (FIGO stages IB2, IIA >2cm, IIB) who received neoadjuvant treatment (chemotherapy or radiochemotherapy) and demonstrated a complete or partial clinical response and early stage endometrioid endometrial cancer (FIGO stages IB, II) were randomly assigned to undergo TB (arm A) or SES (arm B). INTERVENTION Laparoscopic radical hysterectomy with bilateral pelvic lymphadenectomy, using an easily reproducible technique was performed. MEASUREMENTS AND MAIN RESULTS Fifty patients were available for analysis, with 25 women randomly assigned to TB (arm A) and 25 to SES (arm B). The median operative time was 85 minutes for TB vs 115 minutes for SES (p = .001). At multivariate analysis, endometrial cancer (p = .001) and TB (p = .001) were independently associated with shorter operating time. No differences in perioperative outcomes and postoperative complications were observed between the 2 arms. Patients who underwent TB reported less postoperative pain, both at rest (p = .005) and after the Valsalva maneuver (p = .008), with less additional analgesic therapy other than standard therapy required in patients who underwent SES (p = .02). CONCLUSION TB is associated with shorter operative time and less postoperative pain than is the standard technique (SES) in patients with uterine cancer.
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Affiliation(s)
- Anna Fagotti
- Department of Minimally Invasive Gynecology, University of Perugia, St. Maria Hospital, Terni, Italy.
| | - Giuseppe Vizzielli
- Department of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Fanfani
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy
| | - Valerio Gallotta
- Department of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Cristiano Rossitto
- Department of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Barbara Costantini
- Department of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Nicola Avenia
- Department of Minimally Invasive Gynecology, University of Perugia, St. Maria Hospital, Terni, Italy
| | - Raffaella Iodice
- Department of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Department of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy
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Nagarsheth NP, Fenske SS, Shah A, Moshier E, Stahl R, Shander A. In vitro analysis of cell salvage blood collection with a laparoscopic suction device. J Minim Invasive Gynecol 2013; 20:104-6. [PMID: 23312250 DOI: 10.1016/j.jmig.2012.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 10/01/2012] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To determine whether cell salvage blood collection with a laparoscopic suction device is inferior to use of a traditional Yankauer suction device. DESIGN Prospective, in vitro study. SETTING Academic teaching hospital. INTERVENTIONS Individual units of donated packed red blood cells were diluted with normal saline solution to a hematocrit level of 21%. The blood was divided into 2 equal parts and then suctioned with either a laparoscopic suction device or a Yankauer plastic suction catheter tip connected to double-lumen cell salvage tubing with a diluted heparin drip and a vacuum pressure of 100 mm Hg. Collected blood was processed with a cell salvage device. Red blood cell volume was calculated by multiplying the hematocrit level by the total volume of blood product at the time of testing. Mean hemolysis indexes were compared between the laparoscopic and Yankauer method of blood collection by use of a 2-sample t test. Assuming a clinically acceptable limit of loss to be 7%, percent loss in red blood cell volume was tested with a 95% one-sided confidence limit to assess noninferiority. MEASUREMENTS AND RESULTS The mean hemolysis index was 43.33 with laparoscopic suction method and 34.67 with the Yankauer suction method. The mean difference was 8.67 and was not considered significant (p = .074). The percent loss in red blood cell volume after collection and cell salvage processing was 33.2% with the laparoscopic suction method and 29.57% with the Yankauer method. The mean difference was 3.63% and was within the acceptable 7% loss limit for noninferiority (p = .0278). CONCLUSIONS Laparoscopic blood collection is not inferior to the standard Yankauer method for cell salvage collection.
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Affiliation(s)
- Nimesh P Nagarsheth
- Mount Sinai School of Medicine, Department of Obstetrics and Gynecology, 1176 Fifth Ave, New York, NY 10029, USA
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Soliman PT, Langley G, Munsell MF, Vaniya HA, Frumovitz M, Ramirez PT. Analgesic and antiemetic requirements after minimally invasive surgery for early cervical cancer: a comparison between laparoscopy and robotic surgery. Ann Surg Oncol 2012; 20:1355-9. [PMID: 23054117 DOI: 10.1245/s10434-012-2681-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Women with early cervical cancer undergoing radical hysterectomy via minimally invasive surgery (MIS) have decreased blood loss and a shorter hospital stay compared with laparotomy. It remains unclear whether there is a difference in benefit to the patient between robotic surgery and traditional laparoscopy. We sought to compare postoperative analgesic and antiemetic requirements between the two approaches. METHODS After institutional review board approval, the medication administration records of all patients who underwent MIS radical hysterectomy for cervical cancer at MD Anderson Cancer Center were reviewed. Analgesic and antiemetic medication use as well as visual pain scores was recorded. Descriptive statistics and nonparametric tests were used to compare the groups undergoing laparoscopy (LRH) and robotic surgery (RRH). RESULTS A total of 85 patients underwent MIS for early cervical cancer, 55 LRH and 30 RRH. Median age was older in the RRH (42 vs. 52 years, p = 0.001). There was no difference in median body mass index (26.9 vs. 26.8 kg/m(2), p = 0.71). Length of stay was significantly shorter in the RRH (2 vs. 1 day, p = 0.005). Total intravenous opioids administered were significantly higher in the LRH (26.7 mg morphine equivalents) compared with the RRH (10.7 mg morphine equivalents) (p = 0.001). There was no difference in visual pain scores or antiemetics given. CONCLUSIONS Intravenous opioids administered were significantly less for RRH compared to LRH; however, there was no difference in visual pain scores. Prospective studies are being performed to evaluate quality of life in patients undergoing MIS for gynecologic cancers.
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Affiliation(s)
- Pamela T Soliman
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Achavanuntakul K, Charoenkwan K. Factors affecting operative blood loss from open radical hysterectomy and pelvic lymphadenectomy for early-stage cervical cancer. Arch Gynecol Obstet 2012; 286:1001-5. [PMID: 22622853 DOI: 10.1007/s00404-012-2387-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 05/10/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the effect of clinical and tumor factors on operative blood loss during open radical hysterectomy and pelvic lymphadenectomy for early-stage cervical cancer. METHODS Clinical, pathological, and operative data of 456 women with cervical cancer stage IA2-IIA who had open radical hysterectomy with bilateral pelvic lymphadenectomy (RHPL) from January 2003 to December 2005 were reviewed with regard to operative blood loss of 600 ml or more. RESULTS Parity (RR 1.67; 95 % CI 1.02-2.73; p value 0.04) and salpingo-oophorectomy (RR 1.57; 95 % CI 1.06-2.31; p value 0.02) were statistically associated with operative blood loss of 600 ml or more from multivariate analysis. Preoperative chemotherapy (RR 1.87; 95 % CI 1.18-2.96; p value < 0.01) and BMI ≥ 25 kg/m(2) (RR 1.73; 95 % CI 1.08-2.75; p value 0.02) were significantly associated with blood loss of more than 1,000 ml in the multivariate analysis. CONCLUSION High parity (3 or more) and incidental salpingo-oophorectomy are related to an increased risk of operative blood loss of 600 ml or more during open RHPL. However, the effects were marginal and no clear explanation for the underlying mechanisms is available. Preoperative chemotherapy and overweight were independent predictors of operative blood loss of more than 1,000 ml.
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Moss EL, Balega J, Chan KK, Singh K. Surgical and Oncological Outcome of Total Laparoscopic Radical Hysterectomy in Obese Women With Early-Stage Cervical Cancer. Int J Gynecol Cancer 2012; 22:101-6. [DOI: 10.1097/igc.0b013e3182358b56] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveTo evaluate the clinical experience of the total laparoscopic radical hysterectomy (TLRH) for the surgical management of cervical cancer in obese (body mass index [BMI] >30 kg/m2) and nonobese (BMI <30 kg/m2) women.MethodsData were collected prospectively on intraoperative and postoperative parameters and complications for all women undergoing a TLRH for cervical cancer. Patients were classified as obese, BMI >30 kg/m2, or nonobese, BMI <30 kg/m2. Assessment of surgical radicality was made by comparing the excision specimens in the 2 groups with a cohort of open radical hysterectomy cases performed before the introduction of the TLRH.ResultsA total of 58 women underwent a TLRH; 15 (25.9%) were obese and 43 (74.1%) were in the nonobese group. There was no significant difference in intraoperative blood loss or median duration of surgery between the obese and nonobese groups. The median hospital stay in both groups was 3 days (range, 2–13 days). Four cases were converted to laparotomy (7%); all were in the nonobese group. Postoperatively, 3 patients developed ischemic ureterovaginal fistulae (5%) between days 5 and 7 after surgery; all were in the nonobese group. There was no significant difference in the parametrial length, maximum vaginal cuff length, and number of lymph nodes excised between the 2 groups. To date, there has been one recurrence during the median follow-up period of 19 months (range, 3–42 months). She belonged to the nonobese group.ConclusionsThe TLRH is a surgically safe procedure for early-stage cervical cancer. Obesity did not adversely affect the performance of TLRH or the radicality of the excision. In obese women, TLRH should be the favored route of surgery for all women who require a radical hysterectomy owing to its favorable perioperative outcome and short hospital stay.
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Soliman PT, Frumovitz M, Sun CC, Dos Reis R, Schmeler KM, Nick AM, Westin SN, Brown J, Levenback CF, Ramirez PT. Radical hysterectomy: a comparison of surgical approaches after adoption of robotic surgery in gynecologic oncology. Gynecol Oncol 2011; 123:333-6. [PMID: 21872911 DOI: 10.1016/j.ygyno.2011.08.001] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/27/2011] [Accepted: 08/02/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare intra-operative, postoperative and pathologic outcomes of three surgical approaches to radical hysterectomy and bilateral pelvic lymph node dissection over a three year time period during which all three approaches were used. METHODS We reviewed all patients who underwent radical hysterectomy with pelvic lymph node dissection between 1/2007 and 11/2010. Comparison was made between robotic, laparoscopic and open procedures in regard to surgical times, complication rates, and pathologic findings. RESULTS A total of 95 radical hysterectomy procedures were performed during the study period: 30 open (RAH), 31 laparoscopic (LRH) and 34 robotic (RRH). There were no differences in age, body mass index or other demographic factors between the groups. Operative time was significantly shorter in the RAH compared to LRH and RRH (265 vs 338 vs 328min, p=0.002). Estimated blood loss was significantly lower in LRH and RRH compared with RAH (100 vs 100 vs 350mL, p<0.001). Thirteen (24%) of RAH required blood transfusion. Conversion rates were higher in the LRH (16%) compared to RRH (3%) although not significant (p=0.10). Median length of stay was significantly shorter in RRH (1day) vs LRH or RAH (2 vs 4days, p<0.01). Pathologic findings were similar among all groups. CONCLUSION Minimally invasive surgery has made a significant impact on patients undergoing radical hysterectomy including decrease in blood loss and transfusion rates however; operative times were significantly longer compared to open radical hysterectomy. Our findings suggest that the robotic approach may have the added benefit of even shorter length of stay compared to traditional laparoscopy.
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Affiliation(s)
- Pamela T Soliman
- Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
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Reade C, Hauspy J, Schmuck M, Moens F. Characterizing the Learning Curve for Laparoscopic Radical Hysterectomy: Buddy Operating as a Technique for Accelerating Skill Acquisition. Int J Gynecol Cancer 2011; 21:930-5. [DOI: 10.1097/igc.0b013e3182157a44] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Vizza E, Pellegrino A, Milani R, Fruscio R, Baiocco E, Cognetti F, Savarese A, Tomao F, Chen C, Corrado G. Total laparoscopic radical hysterectomy and pelvic lymphadenectomy in locally advanced stage IB2-IIB cervical cancer patients after neoadjuvant chemotherapy. Eur J Surg Oncol 2011; 37:364-9. [DOI: 10.1016/j.ejso.2010.12.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 11/03/2010] [Accepted: 12/06/2010] [Indexed: 11/28/2022] Open
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Abstract
Background:The development of robotic technology has facilitated the application of minimally invasive techniques for complex operations in gynecologic oncology.Objectives:The objective of the study was to assess and summarize the current literature on the role of robot-assisted surgery in cervical cancer in terms of its utility and outcome.Methods:Literature review concerning the use of robot-assisted technology in the management of cervical cancer, including radical hysterectomy, trachelectomy, parametrectomy, pelvic and aortic lymphadenectomy, and pelvic exenteration, was performed.Results:To date, 12 articles addressing radical hysterectomy, 5 articles of radical trachelectomy, and 6 articles of surgical procedure in advanced or recurrent cervical cancer, all performed robotically, are published in the literature. The advantages of the robotic system include 3-dimensional vision, tremor reduction, motion downscaling, improved ergonomics, and greater dexterity with instrument articulation. Because of these benefits, the robotic technology seems to facilitate the surgical approach for technically challenging operations performed to treat primary, early or advanced, and recurrent cervical cancer as evidenced by the current literature.Conclusions:Surgical management of cervical cancer may be one of the gynecologic oncology surgeries that can take full advantage of robotic assistance in a minimally invasive manner. Continued research and clinical trials are needed to further elucidate the equivalence or superiority of robot-assisted surgery to conventional methods in terms of oncological outcome and patient's quality of life.
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Zakashansky K, Bradley WH, Chuang L, Rahaman J, Dottino P. Recent Advances in the Surgical Management of Cervical Cancer. ACTA ACUST UNITED AC 2009; 76:567-76. [DOI: 10.1002/msj.20149] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Malzoni M, Tinelli R, Cosentino F, Perone C, Iuzzolino D, Rasile M, Tinelli A. Laparoscopic radical hysterectomy with lymphadenectomy in patients with early cervical cancer: Our instruments and technique. Surg Oncol 2009; 18:289-97. [DOI: 10.1016/j.suronc.2008.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Revised: 06/14/2008] [Accepted: 07/27/2008] [Indexed: 11/25/2022]
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Abstract
BACKGROUND The resection of a vaginal septum using the Harmonic Scalpel in a patient on anticoagulation is described. CASE A 21-year-old female with bicollis didelphys uterus and a 4-cm vaginal septum underwent resection of the vaginal septum using the ultrasonic scalpel. Hemostasis was noted both during and after the procedure. The patient was given thombophylaxis for 2 weeks perioperatively secondary to her medical history of anti-thrombin III deficiency and deep venous thrombosis. SUMMARY AND CONCLUSION The use of the Harmonic Scalpel appears to be a safe and effective method for resection of vaginal septa. Patient healing time may vary and may take longer than with traditional techniques.
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Affiliation(s)
- Susan M Rose
- Department of Obstetrics and Gynecology, University of Utah Hospitals and Clinics, Salt Lake City, Utah, USA
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Protopapas A, Jardon K, Bourdel N, Botchorishvili R, Rabischong B, Mage G, Canis M. Total Laparoscopic Radical Hysterectomy in the Treatment of Early Cervical Cancer. Int J Gynecol Cancer 2009; 19:712-22. [DOI: 10.1111/igc.0b013e3181a3e2be] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Pellegrino A, Vizza E, Fruscio R, Villa A, Corrado G, Villa M, Dell'Anna T, Vitobello D. Total laparoscopic radical hysterectomy and pelvic lymphadenectomy in patients with Ib1 stage cervical cancer: Analysis of surgical and oncological outcome. Eur J Surg Oncol 2009; 35:98-103. [DOI: 10.1016/j.ejso.2008.07.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Revised: 07/09/2008] [Accepted: 07/14/2008] [Indexed: 10/21/2022] Open
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Pareja R, Ramirez PT. Robotic Radical Hysterectomy in the Management of Gynecologic Malignancies. J Minim Invasive Gynecol 2008; 15:673-6. [DOI: 10.1016/j.jmig.2008.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 07/21/2008] [Accepted: 07/25/2008] [Indexed: 11/22/2022]
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Chuang LT, Lerner DL, Liu CS, Nezhat FR. Fertility-sparing Robotic-assisted Radical Trachelectomy and Bilateral Pelvic Lymphadenectomy in Early-stage Cervical Cancer. J Minim Invasive Gynecol 2008; 15:767-70. [DOI: 10.1016/j.jmig.2008.08.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 08/03/2008] [Accepted: 08/09/2008] [Indexed: 11/27/2022]
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Pellegrino A, Villa A, Fruscio R, Signorelli M, Meroni MG, Iedà N, Vitobello D. Total Laparoscopic Radical Hysterectomy and Pelvic Lymphadenectomy in Early Stage Cervical Cancer. Surg Laparosc Endosc Percutan Tech 2008; 18:474-8. [DOI: 10.1097/sle.0b013e31817e797b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pellegrino A, Fruscio R, Maneo A, Corso S, Battistello M, Chiappa V, Stomati M. Harmonic scalpel versus conventional electrosurgery in the treatment of vulvar cancer. Int J Gynaecol Obstet 2008; 103:185-8. [PMID: 18812244 DOI: 10.1016/j.ijgo.2008.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 07/08/2008] [Accepted: 07/10/2008] [Indexed: 11/24/2022]
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Abstract
OBJECTIVE Advanced laparoscopic procedures are increasing being used in gynecologic surgery. The da Vinci robotic system (Intuitive Surgical Corporation, Sunnyvale, CA) can further augment laparoscopic surgery. We describe our initial experience using the da Vinci robotic system to perform radical hysterectomy. STUDY DESIGN Twenty consecutive patients with primary stage IB-IIA cervical carcinoma underwent class 3 radical hysterectomy with the use of the da Vinci robotic system. Median age was 44 years, median weight was 69.9 kg, 65% of patients had medical comorbidity, and 40% had prior abdominal surgery. RESULTS All 20 patients successfully underwent robotic radical hysterectomy. Median operative time was 6.5 hours (3.5-8.5 hours) and median blood loss was 300 mL. All patients were discharged on the first day after surgery. At median follow-up of 2 years (0.6-3 years), 90% of patients are alive and disease free. CONCLUSION We report the first series of robotic radical hysterectomy for early stage cervical cancer. All cases were successfully performed robotically with minimal complications and all patients were discharged on postoperative day 1.
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Affiliation(s)
- James Fanning
- Department of Obstetrics and Gynecology, Summa Health System, Northeastern Ohio Universities College of Medicine, Akron, OH, USA
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Charoenkwan K, Siriaree S, Cheewakriangkrai C, Srisomboon J. Type III radical hysterectomy and pelvic lymphadenectomy via minilaparotomy: a minimally invasive technique generated promising results when tested in 18 women with early cervical cancer. The goal: a safe and speedy recovery. Am J Obstet Gynecol 2008; 198:716.e1-4. [PMID: 18538164 DOI: 10.1016/j.ajog.2008.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Revised: 03/19/2008] [Accepted: 03/21/2008] [Indexed: 11/24/2022]
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Kang SK, Kunanandam T, Clark L. Prospective, case–control study of surgical efficiency of ultrasonic shear (‘harmonic scalpel’) thyroidectomy compared with conventional thyroidectomy. J Laryngol Otol 2008; 122:1194-6. [PMID: 18282338 DOI: 10.1017/s0022215107001661] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectives and hypothesis:To evaluate the efficacy of ultrasonic shear (‘harmonic scalpel’) thyroidectomy, compared with conventional thyroidectomy.Study design:Prospective, case–control comparison.Methods:Twenty-three consecutive patients were recruited over an eight-month period. Patients were divided into two groups according to their thyroidectomy technique, i.e. ultrasonic shear technique (harmonic scalpel) vs conventional technique (scalpel and bipolar diathermy). Surgical time, thyroidectomy type and thyroid specimen weight were recorded by theatre nursing staff. The ratio of surgical time to specimen weight, in minutes per gram, was used to measure surgical efficiency. The unpaired Student's t-test was used for statistical analysis.Results:The mean surgical time per specimen unit weight was 2.56 min/g for harmonic scalpel thyroidectomy and 5.99 min/g for conventional thyroidectomy. This difference was statistically significant (p = 0.037). The difference was most evident for procedures involving smaller thyroid glands.Conclusions:Our study suggests that thyroidectomy using a harmonic scalpel is more time-efficient than conventional thyroidectomy, especially when operating on smaller thyroid glands.
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Malzoni M, Tinelli R, Cosentino F, Perone C, Vicario V. Feasibility, morbidity, and safety of total laparoscopic radical hysterectomy with lymphadenectomy: Our experience. J Minim Invasive Gynecol 2007; 14:584-90. [PMID: 17848319 DOI: 10.1016/j.jmig.2007.04.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Revised: 03/22/2007] [Accepted: 04/02/2007] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE The purpose of this study was to retrospectively evaluate, in a series of 65 patients, the feasibility, morbidity, and safety of total laparoscopic radical hysterectomy with lymphadenectomy for early cervical carcinoma. DESIGN Retrospective, nonrandomized study (Canadian Task Force classification II-2). SETTING Advanced Gynecological Endoscopy Center, Malzoni Medical Center, Avellino, Italy. PATIENTS Sixty-five nonconsecutive patients with International Federation of Gynecology and Obstetrics (FIGO) stage Ia1 with lymphvascular space involvement, Ia2, and Ib1 early cervical cancer. INTERVENTION Fourteen patients underwent a laparoscopic class II procedure, and 51 patients underwent a class III procedure according to the Piver classification. All the patients underwent total laparoscopic radical hysterectomy with pelvic lymphadenectomy during the study period, and none of the surgeries required conversion to laparotomy. Paraaortic lymphadenectomy is not routinely performed unless suspicious pelvic lymph nodes are confirmed to have metastatic disease on frozen section evaluation. MEASUREMENTS AND MAIN RESULTS Fifty-six patients had squamous cell carcinoma; 7 patients had adenocarcinomas, and 2 had adenosquamous carcinoma. The mean age was 40.5 years (95% CI 27.7-69.1) and the SD was +/- 7.5. The median weight was 56.2 kg (range 44-75 kg). The median operative time was 196 minutes (range 182-240 minutes), and the surgical margins were free of disease in all cases. The median blood loss was 55 mL (range 30-80 mL). No patient required an intraoperative blood transfusion. The median length of hospital stay was 4 days (range 3-7 days). CONCLUSION Laparoscopic treatment of cervical cancer offers patients the potential benefits of decreased discomfort with decreased convalescence time, but it should be reserved for oncologic surgeons trained in extensive laparoscopic procedures.
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Affiliation(s)
- Mario Malzoni
- Advanced Gynecological Endoscopy Center, Malzoni Medical Center, Avellino, Italy
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Zakashansky K, Chuang L, Gretz H, Nagarsheth NP, Rahaman J, Nezhat FR. A case-controlled study of total laparoscopic radical hysterectomy with pelvic lymphadenectomy versus radical abdominal hysterectomy in a fellowship training program. Int J Gynecol Cancer 2007; 17:1075-82. [PMID: 17386041 DOI: 10.1111/j.1525-1438.2007.00921.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
To determine whether total laparoscopic radical hysterectomy (TLRH) is a feasible alternative to an abdominal radical hysterectomy (ARH) in a gynecologic oncology fellowship training program. We prospectively collected cases of all of the patients with cervical cancer treated with TLRH and pelvic lymphadenectomy by our division from 2000 to 2006. All of the patients from the TLRH group were matched 1:1 with the patients who had ARH during the same period based on stage, age, histological subtype, and nodal status. Thirty patients were treated with TLRH with a mean age of 48.3 years (range, 29–78 years). The mean pelvic lymph node count was 31 (range, 10–61) in the TLRH group versus 21.8 (range, 8–42) (P < 0.01) in the ARH group. Mean estimated blood loss was 200 cc (range, 100–600 cc) in the TLRH with no transfusions compared to 520 cc in the ARH group (P < 0.01), in which five patients required transfusions. Mean operating time was 318.5 min (range, 200–464 min) compared to 242.5 min in the ARH group (P < 0.01), and mean hospital stay was 3.8 days (range, 2–11 days) compared to 5.6 days in the ARH group (P < 0.01). All TLRH cases were completed laparoscopically. All patients in the TLRH group are disease free at the time of this report. In conclusion, it is feasible to incorporate TLRH training into the surgical curriculum of gynecologic oncology fellows without increasing perioperative morbidity. Standardization of TLRH technique and consistent guidance by experienced faculty is imperative.
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Affiliation(s)
- K Zakashansky
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Science, The Mount Sinai School of Medicine, Mount Sinai Medical Center, New York, New York, USA
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Abstract
PURPOSE OF REVIEW The indications, techniques and outcomes of laparoscopic associated hysterectomy and especially total laparoscopic hysterectomy are thoroughly reviewed. RECENT FINDINGS The original technique for total laparoscopic hysterectomy is detailed as it is still applicable. The total laparoscopic hysterectomy operation has not changed to any major degree over the past 15 years. The technique detailed works well and lessens the chance for a ureteral injury. Expansion of the technique has occurred in oncology. Evidence-based studies support the use of vaginal hysterectomy if possible over laparoscopic and abdominal hysterectomy. They also support a laparoscopic approach to hysterectomy over total abdominal hysterectomy. SUMMARY Despite evidence-based studies, gynecologic surgical specialists have been slow to adopt both laparoscopic and vaginal hysterectomy into their practice. This trend may increase in the near future. Adoption of laparoscopic associated hysterectomy has been extremely slow.
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Affiliation(s)
- Harry Reich
- Wilkes Barre General Hospital, Wilkes Barre, Pennsylvania, USA.
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Tillmanns T, Lowe MP. Safety, feasibility, and costs of outpatient laparoscopic extraperitoneal aortic nodal dissection for locally advanced cervical carcinoma. Gynecol Oncol 2007; 106:370-4. [PMID: 17509671 DOI: 10.1016/j.ygyno.2007.04.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Revised: 04/04/2007] [Accepted: 04/06/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report on the safety, feasibility, and costs of outpatient laparoscopic extraperitoneal aortic lymph node dissection (LEPSS) for locally advanced cervical carcinoma. METHODS A retrospective analysis of all outpatient LEPSS procedures performed at our institution between August 2005 and February 2007 was performed. All patients with clinical stage IIB-IVA cervical carcinoma with no evidence of bulky aortic lymphadenopathy (>1.0 cm) on pre-operative computed tomography were offered the procedure. If present, pelvic nodal disease could not exceed greater than 1.5 cm. Records were reviewed for demographics, operative findings, complications, length of stay, and CT scan aortic nodal status. As a comparison, the average costs for outpatient LEPSS and outpatient CT, MRI, and PET scan at our institution were calculated. RESULTS A total of eighteen outpatient LEPSS procedures were identified. The median age was 49 (22-72). The median BMI was 29 (18-51). The median operative time was 108 min (60-135 min). The median aortic nodal count was 10 (5-20 nodes). The median blood loss was 25 ml (10-50 ml). There were no intraoperative complications. There was no conversion from a retroperitoneal to a transperitoneal approach. No patient required overnight hospitalization. One patient experienced a lymphocyst postoperatively. There was no delay in the initiation of chemoradiation for any of the patients with a median onset of 10 days from the date of surgery. At least 20% of the patients had one or more medical co-morbidities such as obesity, diabetes, hypertension, or a prior abdominal surgery. Occult aortic nodal metastasis was detected in 11% of the patients with a negative pre-operative CT scan. The average calculated costs at our institution for outpatient LEPSS was $5233 dollars versus $1520 dollars for CT scan, $4830 dollars for MRI and $5494 dollars for a PET scan. CONCLUSIONS To our knowledge this is the first reported experience of outpatient laparoscopic extraperitoneal aortic lymph node dissection for locally advanced cervical cancer. Outpatient LEPSS appears to be a safe and feasible procedure in the hands of an experienced surgeon, however further study is warranted. From a cost analysis perspective, outpatient LEPSS appears equivalent to PET scan and MRI, but is more expensive than CT scan.
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Affiliation(s)
- Todd Tillmanns
- The West Clinic Center for Gynecologic Oncology, 100 North Humphreys Boulevard, Memphis, TN 38120, USA
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Frumovitz M, dos Reis R, Sun CC, Milam MR, Bevers MW, Brown J, Slomovitz BM, Ramirez PT. Comparison of total laparoscopic and abdominal radical hysterectomy for patients with early-stage cervical cancer. Obstet Gynecol 2007; 110:96-102. [PMID: 17601902 DOI: 10.1097/01.aog.0000268798.75353.04] [Citation(s) in RCA: 176] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare intraoperative, pathologic, and postoperative outcomes of total laparoscopic radical hysterectomy with abdominal radical hysterectomy and pelvic lymphadenectomy for women with early-stage cervical cancer. METHODS We reviewed all patients who underwent total laparoscopic radical hysterectomy or abdominal radical hysterectomy and pelvic lymphadenectomy between 2004 and 2006. RESULTS Fifty-four patients underwent abdominal radical hysterectomy, and 35 underwent total laparoscopic radical hysterectomy. Mean age was 41.8 years, and mean body mass index 28.1. There was no difference in demographic or tumor factors between the two groups. Mean estimated blood loss was 548 mL with abdominal radical hysterectomy compared with 319 mL with total laparoscopic radical hysterectomy (P=.009), and 15% of patients who underwent abdominal radical hysterectomy required a blood transfusion compared with 11% who underwent total laparoscopic radical hysterectomy (P=.62). Mean operative time was 307 minutes for abdominal radical hysterectomy compared with 344 minutes for total laparoscopic radical hysterectomy (P=.03). On pathologic examination, there was no significant difference in the amount of parametrial tissue, vaginal cuff, or negative margins obtained. A mean 19 pelvic nodes were obtained during abdominal radical hysterectomy compared with 14 during total laparoscopic radical hysterectomy (P=.001). The median duration of hospital stay was significantly shorter for total laparoscopic radical hysterectomy (2.0 compared with 5.0 days, P<.001). For abdominal radical hysterectomy, 53% of patients experienced postoperative infectious morbidity compared with 18% for total laparoscopic radical hysterectomy (P=.001). There was no difference in postoperative noninfectious morbidity. There was no difference in return of urinary function. CONCLUSION Total laparoscopic radical hysterectomy reduces operative blood loss, postoperative infectious morbidity, and postoperative length of stay without sacrificing the size of radical hysterectomy specimen margins; however, total laparoscopic radical hysterectomy is associated with increased operative time.
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Affiliation(s)
- Michael Frumovitz
- Department of Gynecologic Oncology, the University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
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Bibliography. Current world literature. Minimally invasive gynecologic procedures. Curr Opin Obstet Gynecol 2007; 19:402-5. [PMID: 17625426 DOI: 10.1097/GCO.0b013e3282ca75fc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Frumovitz M, Ramirez PT. Total laparoscopic radical hysterectomy: Surgical technique and instrumentation. Gynecol Oncol 2007; 104:13-6. [PMID: 17157362 DOI: 10.1016/j.ygyno.2006.10.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Accepted: 10/12/2006] [Indexed: 10/23/2022]
Affiliation(s)
- Michael Frumovitz
- Department of Gynecologic Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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Panici PB, Plotti F, Zullo MA, Muzii L, Manci N, Palaia I, Ruggiero A, Angioli R. Pelvic lymphadenectomy for cervical carcinoma: Laparotomy extraperitoneal, transperitoneal or laparoscopic approach? A randomized study. Gynecol Oncol 2006; 103:859-64. [PMID: 16806442 DOI: 10.1016/j.ygyno.2006.05.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Revised: 05/07/2006] [Accepted: 05/17/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To compare transperitoneal, extraperitoneal and laparoscopic pelvic lymphadenectomy in terms of feasibility and morbidity in patients affected by cervical cancer undergoing radical hysterectomy. METHODS Consecutive patients affected by stage IB-IIB cervical carcinoma scheduled for radical surgery entered the study. Patients were randomly assigned to transperitoneal (TPL), extraperitoneal (EPL) or laparoscopic pelvic lymphadenectomy (LPL). All patients underwent classical radical hysterectomy. Perioperative data were recorded. Follow up examinations were performed at the 15th, 30th and 60th day after surgery. RESULTS 168 patients entered the study. The mean operative times were: 63+/-7.6, 54+/-6.7 and 75+/-8.4 min (TPL vs EPL P<0.001; EPL vs LPL P<0.001; TPL vs LPL P<0.001) for TPL, EPL and LPL respectively. The feasibility of the procedures, analyzed on an intention-to-treat basis, was 96%, 93% and 95% for TPL, EPL and LPL group respectively (P=ns). The average hospitalizations were: 5.6+/-0.9, 3.2+/-0.4 and 3.1+/-0.3 days (TPL vs EPL P<0.001; TPL vs LPL P<0.001) for TPL, EPL and LPL respectively. CONCLUSIONS EPL and LPL are as feasible and effective as TPL and can be adequately performed with a reasonable complication rate. LPL showed a statistically significant longer operative time. However, both EPL and LPL can minimize some postoperative complications reducing length of stay.
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Nezhat F, Nagarsheth NP. Response. J Minim Invasive Gynecol 2006. [DOI: 10.1016/j.jmig.2006.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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