“Cervical cancer: Clinical practice guidelines in oncology.”
Greer, B. E., W. J. Koh, et al. (2010).
JNCCN Journal of the National Comprehensive Cancer Network 8(12): 1388-1416.
Cervical cancer is decreasing in the United States because of the wide use of screening; however, it is increasing in developing countries (∼270,000 deaths per year), because screening is not available to many women. Effective treatment for cervical cancer (including surgery and concurrent chemoradiation) can yield cures in 80% of women with early-stage disease (stages I-II) and in 60% of women with stage III disease. The hope is that immunization against HPV (using the new vaccines) will prevent persistent infection with certain types of the virus, and will therefore prevent specific HPV cancer in women. © JNCCN-Journal of the National Comprehensive Cancer Network.
“Indications for minimally invasive surgery for ovarian cancer.”
Han, E. S. and M. Wakabayashi (2011).
JNCCN Journal of the National Comprehensive Cancer Network 9(1): 126-132.
Epithelial ovarian cancer is often diagnosed in advanced stages and typically managed with surgical debulking followed by chemotherapy. For patients with presumed early-stage ovarian cancer, comprehensive surgical staging is essential for management, because 31% are upstaged. Over the past 15 years, minimally invasive techniques have improved and are increasingly being used to treat patients with ovarian cancer. Currently, only retrospective data support laparoscopic staging of patients with a suspicious adnexal mass or those surgically diagnosed with presumed early-stage ovarian cancer. Laparoscopy is also used in patients undergoing second-look procedures and to help evaluate whether patients should undergo optimal tumor debulking procedures or be initially managed with neoadjuvant chemotherapy. Randomized clinical studies are needed to further support the role of minimally invasive surgery in the treatment of ovarian cancer. © JNCCN-Journal of the National Comprehensive Cancer Network.
“A comparative detail analysis of the learning curve and surgical outcome for robotic hysterectomy with lymphadenectomy versus laparoscopic hysterectomy with lymphadenectomy in treatment of endometrial cancer: A case-matched controlled study of the first one hundred twenty two patients.”
Lim, P. C., E. Kang, et al. (2011).
Gynecologic Oncology 120(3): 413-418.
GOAL: To determine the learning curve and surgical outcome for the first one hundred twenty-two robotic hysterectomy with lymphadenectomy patients in comparison to the first one hundred twenty-two patients who underwent the same procedure laparoscopically. MATERIALS AND METHODS: An analysis of the first 122 patients who underwent a robotic assisted hysterectomy with lymphadenectomy (RHBPPALND) was compared to the first 122 patients who underwent a total laparoscopic hysterectomy with lymphadenectomy (LHBPPALND). The learning curve of the surgical procedure was determined by measuring operative time with respect to chronological order of each patient who had undergone their respective procedure. Number of lymph nodes, estimated blood loss, days of hospitalization, and complications of all patients were also analyzed and compared. RESULTS: The learning curve of the surgical procedure was determined by measuring operative time with respect to chronological order of each patient who had undergone their respective procedure. Data were analyzed for mean age, body mass index, operative time, estimated blood loss, lymph node retrieval and complications for both surgical procedures. The mean operative time was 147.2+/-48.2 and 186.8+/-59.8 for RHBPPALND and LHBPPALND respectively. The mean EBL was statistically significant at 81.1+/-45.9 and 207.4+/-109.4 for RHBPPALND and LHBPPALND respectively. The total number of pelvic and aortic lymph nodes was 25.1+/-12.7 for RHBPPALND and 43.1+/-17.8 for LHBPPALND. The number of pelvic lymph node was 19.2+/-9.0 and 24.7+/-11.9 for RHBPPALND and LHBPPALND. The days of hospitalization of RHBPPALND and LHBPPALND were 1.5+/-0.9 and 3.2+/-2.3. The number of intraoperative complications for RHBPPALND, and LHBPPALND was 1 and 7, respectively. CONCLUSION: Robotic hysterectomy with lymphadenectomy has a faster learning curve in comparison to laparoscopic hysterectomy with lymphadenectomy. The adequacy of surgical staging was comparable between the two surgical methods. RHBPPALND is associated with shorter hospitalization, less blood loss and less intraoperative and major complications, and lower rate of conversion to open procedure.
“Side-docking in robotic-assisted gynaecologic cancer surgery.”
Woods, D. L., J. Y. Hou, et al. (2011).
Int J Med Robot 7(1): 51-54.
BACKGROUND: The majority of previous experience with the robotic-sssisted laparoscopic technique for gynaecological procedures has utilized a method in which the robot is centrally located (CD) between the patient’s legs. METHODS: Twelve consecutive patients undergoing robotic-assisted procedures for gynaecological malignancies were positioned in a side-docking (SD) fashion, in which the robot is positioned lateral to the patient. The relevant clinical parameters were collected and compared to the previous 12 patients undergoing surgery using the conventional, centre-docking (CD) technique. RESULTS: Specimen retrieval time for larger uteri was reduced in the SD group compared to the CD group (p = 0.03). Total operative times were slightly lower in the SD group and specimen retrieval times for all uterine weights were unchanged when compared to the CD group. Statistical significance was not observed. CONCLUSIONS: Side-docking is an alternative to the conventional centre-docking approach in robotic-assisted surgery. Its use may facilitate larger specimen retrieval while decreasing operative time and associated costs. Copyright (c) 2011 John Wiley & Sons, Ltd.
“Laparoscopic sacrocolpopexy for the treatment of vaginal vault prolapse: with or without robotic assistance.”
Chan, S. S., S. M. Pang, et al. (2011).
Hong Kong Med J 17(1): 54-60.
OBJECTIVE. To assess perioperative and medium-term outcome after laparoscopic sacrocolpopexy with or without robotic assistance for vaginal vault prolapse in a Hong Kong tertiary centre. DESIGN. Retrospective study. SETTING. An urogynaecology unit in Hong Kong. PATIENTS. All women who underwent laparoscopic sacrocolpopexy with or without robotic assistance for vaginal vault prolapse from March 2005 to May 2010. MAIN OUTCOME MEASURES. The perioperative and medium-term outcomes. RESULTS. A total of 36 women underwent the operation during the study period. The mean operating time was 205 minutes, mean blood loss was 144 mL. The median hospital stay was 4 days. Two women required early re-operation but recovered fully. In all, 35 women were followed up for 29 (standard deviation, 19) months. Three of them (9%) had a recurrence of stage II prolapse, but there was statistically significant improvement in the pelvic organ prolapse quantification assessment for all three compartments of the vagina, and the length of vagina was well preserved. There were no mesh exposure or erosions. The overall objective cure rate of 91% (32/35) was high, and 91% (32/35) were satisfied with the operative outcome. Stress incontinence and voiding difficulty were significantly reduced. CONCLUSION. Laparoscopic sacrocolpopexy for vaginal vault prolapse is safe, although complications arising from concomitant surgery should not be neglected. High rates of objective cures and patient satisfaction were achieved. There were no mesh exposure or erosions. Laparoscopic sacrocolpopexy should be considered an option for women with vaginal vault prolapse.
“Long-Term Outcomes after Robotic Sacrocolpopexy in Pelvic Organ Prolapse: Prospective Analysis.” Moreno Sierra, J., E. Ortiz Oshiro, et al. (2011).
Objective: To evaluate the feasibility and long-term outcomes of our initial series of robot-assisted laparoscopic sacrocolpopexy. Methods: We conducted a prospective analysis of our series of robotic sacrocolpopexy. Inclusion criteria: patients with grades III and IV cystocele and or other symptomatic pelvic organ prolapse. We performed a transperitoneal four-trocar technique with the Da Vinci robotic system using two polypropylene meshes for fixation to the sacral promontory. The primary outcome was recurrence; secondary outcomes included operating room time, blood loss, conversion to open surgery, complications and length of stay. Results: 31 consecutive procedures were included. Mean patient age was 65.2 (50-81) years. Mean operating room time was 186 (150-230) min. We converted 1 case to laparoscopy (3.2%). There were two major complications (1 acute myocardial infarction and 1 reoperation for excess tension with syncopes), two minor complications (1 wound infection and 1 ileus) and no recurrences at a mean follow-up of 24.5 (16-33) months. Conclusions: Robotic sacrocolpopexy could possibly improve with experience after overcoming the learning curve. There is no doubt it is a reproducible technique, but its safety and efficacy still need to be proven. Our initial series demonstrated good outcomes and no recurrences at 24.5 months of follow-up.