1
|
Imai K, Hirooka-Nakama J, Hotta Y, Shigeta H. A Review of Laparoscopic Para-aortic Lymphadenectomy for Early-stage Endometrial Cancer: Extraperitoneal Approach May Have the Advantage over Intraperitoneal Approach. Gynecol Minim Invasive Ther 2024; 13:10-18. [PMID: 38487605 PMCID: PMC10936721 DOI: 10.4103/gmit.gmit_25_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/29/2023] [Accepted: 09/21/2023] [Indexed: 03/17/2024] Open
Abstract
The importance of lymphadenectomy, including para-aortic nodes, for the accurate staging of endometrial cancer, is well established. Although the therapeutic role of lymph node resection in endometrial cancer is still under debate, some studies support its usefulness for survival benefit. To predict the necessity of lymphadenectomy, several preoperative scoring systems have been proposed as being effective. For endometrial cancer, there is a trend towards minimally invasive surgery, including para-aortic lymphadenectomy. For para-aortic lymphadenectomy, there are two different approaches: the extraperitoneal approach and the transperitoneal approach. The extraperitoneal approach has advantages over the transperitoneal approach in terms of better access to the left aortic nodes, no interference of the bowel, and possibly better options for obese or elderly patients. However, the extraperitoneal approach may have a longer learning curve than the transperitoneal approach. Robot-assisted extraperitoneal para-aortic lymphadenectomy is feasible and safe and may be suitable for patients irrespective of their baseline characteristics.
Collapse
Affiliation(s)
- Kazuaki Imai
- Department of Obstetrics and Gynecology, Yokohama Municipal Citizen’s Hospital, Japan
| | - Junko Hirooka-Nakama
- Department of Obstetrics and Gynecology, Yokohama Municipal Citizen’s Hospital, Japan
| | - Yuichiro Hotta
- Department of Obstetrics and Gynecology, Yokohama Municipal Citizen’s Hospital, Japan
| | - Hiroyuki Shigeta
- Department of Obstetrics and Gynecology, Yokohama Municipal Citizen’s Hospital, Japan
| |
Collapse
|
2
|
Chuang YC, Chen YC, Huang JH, Chiu KM. Robotic management of severe hemorrhage during para-aortic lymph node dissection. Asian J Surg 2023; 46:1526. [PMID: 36357281 DOI: 10.1016/j.asjsur.2022.09.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/14/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Yi-Chen Chuang
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yen-Cheng Chen
- Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Jih-Hsin Huang
- Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuan-Ming Chiu
- Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
| |
Collapse
|
3
|
Robot-assisted Extraperitoneal Para-aortic Lymphadenectomy Is Associated with Fewer Surgical Complications: A Post Hoc Analysis of the STELLA-2 Randomized Trial. J Minim Invasive Gynecol 2021; 28:2004-2012.e1. [PMID: 34022445 DOI: 10.1016/j.jmig.2021.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To evaluate if extraperitoneal para-aortic lymphadenectomy (PALND) using a robot-assisted approach was associated with fewer complications than all other approaches (conventional laparoscopic transperitoneal or extraperitoneal and robot-assisted transperitoneal) without compromising lymph node yield, operative time, or length of stay. DESIGN Post hoc analysis of the prospective randomized open-label multicenter trial (STELLA-2). SETTING Three academic referral hospitals. PATIENTS Two hundred and three eligible patients from the STELLA-2 trial were included. INTERVENTIONS The patients were randomized to extraperitoneal or transperitoneal PALND using a minimally invasive approach (either laparoscopic or robot-assisted) for surgical staging of endometrial or ovarian cancer. The minimally invasive approaches were not subjected to randomization. MEASUREMENTS AND MAIN RESULTS The primary end point was evaluated through a composite variable that included at least 1 of the following events: blood loss ≥500 mL during PALND, any intraoperative complication related to PALND, severe postoperative complication (Clavien-Dindo ≥grade IIIA), impossibility of completing the procedure, or conversion to laparotomy. Of the 203 patients analyzed, 68 were assigned to the extraperitoneal laparoscopic group (X-L), 62 to the transperitoneal laparoscopic group (T-L), 35 to the extraperitoneal robotic group (X-R), and 38 to the transperitoneal robotic group (T-R). A reduced trend in complications was observed in the extraperitoneal robot-assisted arm when considering the primary end point (X-L: 25.0%, T-L: 24.2%, X-R: 5.7%, T-R: 28.9%; p = .073). In a multivariable analysis, age (odds ratio [OR] 1.05; 95% confidence interval [CI], 1.00-1.09), body mass index (OR 1.09; 95% CI, 1.03-1.16), and waist-to-hip ratio (OR 1.66; 95% CI, 1.12-2.47) were found to independently increase the risk of PALND complications, whereas the extraperitoneal robotic approach (OR 0.13; 95% CI, 0.02-0.64) was an independent protective factor for complication occurrence. CONCLUSION Robot-assisted extraperitoneal PALND is associated with fewer surgical complications, without compromising lymph node retrieval, operative time, or length of stay. Robot-enhanced 3D visualization, surgeon ergonomics, or hemostatic precision could explain our results.
Collapse
|
4
|
Docking for robotic extraperitoneal para-aortic lymphadenectomy with Da Vinci Xi surgical system. J Gynecol Obstet Hum Reprod 2021; 50:102131. [PMID: 33781970 DOI: 10.1016/j.jogoh.2021.102131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 11/22/2022]
Abstract
Regarding extraperitoneal para-aortic lymphadenectomy, installation is key when performed with the assistance of the Da Vinci Xi robotic system. We developed a step-by-step guide, from patient installation to placement of the trocars to patient cart docking, to perform in the efficient and safest installation possible this procedure. The operation does not differ from standard laparoscopic extraperitoneal lymphadenectomy. The benefits of robotic surgery in this indication are comparable to those of the standard laparoscopic approach. Those benefits imply a precise knowledge of the management and installation of the da Vinci Xi robotic system.
Collapse
|
5
|
Loverix L, Salihi RR, Van Nieuwenhuysen E, Concin N, Han S, van Gorp T, Vergote I. Para-aortic lymph node surgical staging in locally-advanced cervical cancer: comparison between robotic versus conventional laparoscopy. Int J Gynecol Cancer 2020; 30:466-472. [PMID: 32079714 DOI: 10.1136/ijgc-2019-000961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/26/2019] [Accepted: 01/10/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE With the expansion of the use of minimally invasive surgical techniques within the field of gynecological oncology, a robot assisted procedure seems to be an attractive technique for para-aortic lymph node sampling. The aim of this study was to compare robotic versus conventional laparoscopic para-aortic lymphadenectomy in patients with locally advanced cervical cancer. METHODS In this monocentric retrospective study, we included patients with locally-advanced cervical cancer (International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IB2-IVA or IB1 with suspicious pelvic lymph nodes), who underwent a para-aortic lymphadenectomy up to the inferior mesenteric artery between December 1994 and December 2016 (robotic technique starting from December 2012). RESULTS A total of 217 patients were included in the study (robotic, n=55 vs laparoscopic, n=162). When comparing conventional laparoscopic versus robotic para-aortic lymphadenectomy, the median age was 48 versus 49 years and the median body mass index was 24.4 vs 24.7 kg/m2, respectively. In the robotic or laparoscopic group, 85% and 83% were squamous carcinomas, respectively. Patients who underwent a robotic procedure had a higher American Society of Anesthesiologists (ASA) score (ASA2: 62% vs 56%, ASA3: 20% vs 2%, p<0.001), more prior major abdominal surgery (18% vs 6%, p=0.016), less estimated blood loss (median, 25 mL vs 62.5 mL, p<0.001), more para-aortic lymph nodes removed (11 vs 6, p<0.001), shorter postoperative stay (1.8 vs 2.3 days, p=0.002), and a higher, but non-significant, rate of metastatic para-aortic lymph nodes (13% vs 5%, p=0.065) compared with the laparoscopic procedure, respectively. There was no difference in complication rates between the two approaches. The most frequent complications were grade I and grade II according to the Clavien Dindo classification. No difference was observed in progression-free survival between robotic and laparoscopic para-aortic lymphadenectomy after 2 years (both groups 66%) (p=0.472). Also, 2 year overall survival was similar between the groups (77% vs 81% for robotic vs conventional laparoscopy group, respectively) (p=0.749). CONCLUSION Robotic para-aortic lymphadenectomy in patients with locally-advanced cervical cancer resulted in better perioperative outcomes and similar survival outcomes when compared with a conventional laparoscopic approach.
Collapse
Affiliation(s)
- Liselore Loverix
- Gynecological Oncology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Rawand Rokan Salihi
- Gynecological Oncology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Els Van Nieuwenhuysen
- Gynecological Oncology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Nicole Concin
- Department of Gynecology and Obstetrics; Innsbruck Medical Univeristy, Innsbruck, Austria
| | - Sileny Han
- Gynecological Oncology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Toon van Gorp
- Gynecological Oncology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| | - Ignace Vergote
- Gynecological Oncology, KU Leuven University Hospitals Leuven, Leuven, Flanders, Belgium
| |
Collapse
|
6
|
Houvenaeghel G, Bannier M, Rua S, Barrou J, Heinemann M, Knight S, Lambaudie E, Cohen M. Robotic breast and reconstructive surgery: 100 procedures in 2-years for 80 patients. Surg Oncol 2019; 31:38-45. [DOI: 10.1016/j.suronc.2019.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 08/05/2019] [Accepted: 09/09/2019] [Indexed: 11/24/2022]
|
7
|
Technical Aspects of Endosurgical Extraperitoneal Aortic Lymph Node Dissection in Gynaecologic Oncology. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-019-0354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
8
|
Houvenaeghel G, Bannier M, Rua S, Barrou J, Heinemann M, Lambaudie E, Cohen M. Skin sparing mastectomy and robotic latissimus dorsi-flap reconstruction through a single incision. World J Surg Oncol 2019; 17:176. [PMID: 31677640 PMCID: PMC6825710 DOI: 10.1186/s12957-019-1711-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/12/2019] [Indexed: 11/21/2022] Open
Abstract
Background Robotic latissimus dorsi-flap reconstruction (RLDFR) after skin-sparing mastectomy (SSM) for breast cancer (BC) has been performed through a single nipple incision. We report results of SSM with RLDFR, mainly with analysis of feasibility, morbidity, indications, and technique standardization. Methods We determined characteristics of patients, previous treatment of BC, and type of reconstruction. Surgical technique, duration of surgery, and complication rate were reported according to three successive periods: P1–3. Results Forty RLDFR, with breast implant for 16 patients, with previous breast radiotherapy in 30% had been performed. In logistic regression, factors significantly associated with duration of surgery ≥ 300 min were P2 (OR 0.024, p = 0.004) and P3 (OR 0.012, p = 0.004) versus P1. The median mastectomy weight was 330 g and 460 g for BMI < and ≥ 23.5 (p = 0.025). Length of hospitalization was 4 days. Total complication rate was 20% (8/40): seven breast complications (four re-operations) and one RLDF complication with re-operation. Periods were significantly predictive of complications (p = 0.045). Conclusion SSM with RLDFR is feasible, safe, and reproducible. We reported a decrease of duration of surgery, length of post-operative hospitalization, and complication rate.
Collapse
Affiliation(s)
- Gilles Houvenaeghel
- Department of Surgical Oncology, Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France.
| | - Marie Bannier
- Department of Surgical Oncology, Paoli Calmettes Institute, Marseille, France
| | - Sandrine Rua
- Department of Surgical Oncology, Paoli Calmettes Institute, Marseille, France
| | - Julien Barrou
- Department of Surgical Oncology, Paoli Calmettes Institute, Marseille, France
| | - Mellie Heinemann
- Department of Surgical Oncology, Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| | - Eric Lambaudie
- Department of Surgical Oncology, Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| | - Monique Cohen
- Department of Surgical Oncology, Paoli Calmettes Institute, Marseille, France
| |
Collapse
|
9
|
Robotic-Assisted Infrarenal Para-aortic Lymphadenectomy in Gynecological Cancers: Technique and Surgical Outcomes. Int J Gynecol Cancer 2019; 28:951-958. [PMID: 29683877 DOI: 10.1097/igc.0000000000001249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Mini-invasive surgery has essentially replaced open laparotomy in surgery for endometrial and cervical carcinoma. Of the procedures needed for a complete staging, especially para-aortic lymphadenectomy (PALND) is challenging to perform. The present study was undertaken to investigate the technical and surgical outcomes of robotic-assisted PALND for gynecological cancers in the setting of a tertiary university hospital in Finland. METHODS This was a retrospective chart review of 283 robotic-assisted para-aortic lymphadenectomies using the single-docking transperitoneal technique performed at the Department of Obstetrics and Gynecology of Tampere University Hospital, in 2009-2016. The primary outcome measure was the extent of the operation in terms of the height, that is, how often the level cranial to the inferior mesenteric artery (IMA) was achieved. The secondary outcome measures included operation time and surgical outcome. RESULTS The majority of operations (n = 239 [84.4%]) were performed for endometrial carcinoma. The most common operation type was robotic-assisted hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy and PALND, which took a median of 3:38 hours or 218 minutes (range, 140-341 minutes) to perform. The high PALND (above the level of IMA) succeeded in 235 operations (83%). In the total cohort, the median number of para-aortic lymph nodes removed was 12 (range, 0-38), with a learning curve approximately more than 40 operations. Para-aortic lymph node metastases were found in 43 patients (15.2%). Seven conversions to laparotomy (2.5%) were done. The conversion and intraoperative complication rates were 2.5% and 3.5%, respectively, and postoperative complications was 18%, according to the classification of Clavien-Dindo. The median length of the postoperative hospital stay was 2 days (range, 1-8 days). CONCLUSIONS Using the transperitoneal technique for PALND, the area between IMA and the renal veins can be reached in more than 80% of the operations, with a very low or 2.5% conversion rate.
Collapse
|
10
|
Houvenaeghel G, Bannier M, Rua S, Barrou J, Heinemann M, Van Troy A, Lambaudie E, Cohen M. Breast cancer robotic nipple sparing mastectomy: evaluation of several surgical procedures and learning curve. World J Surg Oncol 2019; 17:27. [PMID: 30728011 PMCID: PMC6366058 DOI: 10.1186/s12957-019-1567-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies of robotic nipple sparing mastectomy (NSM) were reported. We report feasibility of robotic NSM and determine standard surgical procedure and learning curve threefold. METHODS A cohort of patients with robotic NSM for breast cancer was analyzed. Complications and post-operative hospitalization stay were reported. The same technic was used for all patients except for skin and nipple areolar complex (NAC) dissection. Differences between three surgical procedures of NAC dissection were analyzed: group 1, dissection with robotic scissors using coagulation; group 2, dissection with robotic scissors without coagulation; and group 3, dissection with non-robotic scissors and then robotic dissection. We explored possible effect of learning curve among patients from group 1 with the same surgical procedure. RESULTS Twenty-seven NSM with immediate breast reconstruction for breast cancers, 22 invasive and 5 in situ, were performed, with robotic latissimus dorsi-flap (RLDF) only in 17 cases, RLDF and breast implant in 6 cases, and implant alone in 4 cases. Repartition according to 3 surgical procedure groups was 16, 5, and 6 patients. Mean time of surgery and anesthesia decrease according to groups 1 to 3. Among 16 patients from group 1, time of surgery and anesthesia decreased with learning curve. Post-operative hospitalization decreased from group 1 to 3. We reported a total of 11 complications, with significant difference between groups (10 for group 1). Skin complications were higher for group 1 in comparison with groups 2-3 (p = 0.02). CONCLUSION Robotic NSM can be performed with a brief learning. Standardized technique is proposed with non-robotic scissors superficial dissection and then dissection with robot.
Collapse
Affiliation(s)
- G Houvenaeghel
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France.
| | - M Bannier
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| | - S Rua
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| | - J Barrou
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| | - M Heinemann
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| | - A Van Troy
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| | - E Lambaudie
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| | - M Cohen
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| |
Collapse
|
11
|
Gallotta V, Federico A, Gaballa K, D'Indinosante M, Conte C, Giudice MT, Naldini A, Lodoli C, Rotolo S, Gallucci V, Tortorella L, Romanò B, Scambia G, Ferrandina G. The role of robotic aortic lymphadenectomy in gynecological cancer: surgical and oncological outcome in a single institution experience. J Surg Oncol 2018; 119:355-360. [PMID: 30554410 DOI: 10.1002/jso.25335] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 11/25/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVE This study aims to investigate the surgical outcomes observed in robotic transperitoneal aortic lymphadenectomy (AL) in gynecological cancer patients. METHODS Retrospective data were collected and analyzed on 71 patients undergoing robotic surgical procedures for gynecological cancers, including transperitoneal AL, between December 2014 and February 2018 at the Catholic University of the Sacred Heart, Rome, Italy. RESULTS Median age of the sample population was 50 years (range, 26-76 years). The median operative time was 210 minutes (range, 75-480 minutes), the median estimated blood loss was 50 ml (range, 20-300 ml). The number of para-aortic nodes removed was 12 (range, 7-43). In the whole series, 13 patients (18.3%) had at least one metastatic node. Overall, 10 patients (14.1%) experienced any grade early postoperative complications. Three patients experienced more than one complication. Three intraoperative complications occurred with two cases of vascular injury. Conversion to laparotomy was necessary for one patient (1.4%). CONCLUSIONS The present study shows the safety and adequacy of robotic transperitoneal AL as surgical staging step for gynecological cancers in terms of perioperative and postoperative outcomes.
Collapse
Affiliation(s)
- Valerio Gallotta
- Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alex Federico
- Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Khaled Gaballa
- Division of Surgical Oncology, Oncology Center Mansoura University, Mansoura, Egypt
| | - Marco D'Indinosante
- Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmine Conte
- Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Teresa Giudice
- Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelica Naldini
- Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudio Lodoli
- Division of General Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefano Rotolo
- Division of General Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valeria Gallucci
- Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lucia Tortorella
- Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Bruno Romanò
- Institute of Intensive Care Medicine and Anesthesiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriella Ferrandina
- Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Ginecologia e Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
12
|
Arora V, Somashekhar S. Essential surgical skills for a gynecologic oncologist. Int J Gynaecol Obstet 2018; 143 Suppl 2:118-130. [DOI: 10.1002/ijgo.12619] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Vivek Arora
- Royal Hospital for Women; University of New South Wales Randwick; Sydney Australia
| | - S.P. Somashekhar
- Manipal Comprehensive Cancer Center; Manipal Hospital; Bangalore India
| |
Collapse
|
13
|
da Costa AG, Borghesi Y, Hudry D, Faes J, Bresson L, Narducci F, Leblanc E. Extraperitoneal Para-Aortic Lymphadenectomy by Robot-Assisted Laparoscopy. J Minim Invasive Gynecol 2018; 25:861-866. [PMID: 29337211 DOI: 10.1016/j.jmig.2017.10.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 10/22/2017] [Accepted: 10/24/2017] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To evaluate the outcomes of extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy. DESIGN A retrospective study (Canadian Task Force classification III). SETTING An academic institution. PATIENTS Twenty-three consecutive patients with gynecologic cancer who presented for para-aortic lymphadenectomy between March 2016 and May 2017 were reviewed retrospectively. INTERVENTIONS Extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy was performed. MEASUREMENTS AND MAIN RESULTS Of the 23 patients reviewed retrospectively, 10 had cervical cancer, 7 had endometrial cancer, 5 had adnexal cancer, and 1 had vaginal cancer. Data regarding patient characteristics, indication for para-aortic lymphadenectomy, type of surgery (infrarenal or inframesenteric), operative time, surgical complications, number of nodes retrieved, and postoperative hospital length of stay were collected. Two patients were excluded because of early perforation of the peritoneum. In total, 21 para-aortic lymphadenectomies were performed (16 infrarenal and 5 inframesenteric). The median skin-to-skin operating time of infrarenal extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy was 170 minutes (range, 90-225 minutes), the median lymph node count was 18 (range, 11-38), and the median estimated blood loss was 50 mL (range, 10-600 mL). The median skin-to-skin operating time of inframesenteric extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy was 120 minutes (range, 90-220 minutes), the median lymph node count was 10 (range, 7-19), and the median estimated blood loss was 30 mL (range, 10-100). Intraoperative complications included 1 thermal lesion of the left genitofemoral nerve, 1 thermal lesion of the left mesoureter (a ureteral stent was placed to avoid ureteric necrosis and fistula without after effect), and 1 lesion of the inferior vena cava that was sutured by robot-assisted laparoscopy. There were 2 additional cases of perforation of the peritoneum that occurred in the infrarenal group. The median hospital length of stay was 1 day (range, 0-7 days). Three patients were readmitted for symptomatic lymphocysts. CONCLUSION Extraperitoneal para-aortic lymphadenectomy by robot-assisted laparoscopy provides good visualization of the operative field without arm conflict. Still, perforation of the peritoneum and symptomatic lymphocysts are a postoperative concern.
Collapse
Affiliation(s)
- Ana Gomes da Costa
- Department of Gynecologic Oncology, Oscar Lambret Cancer Center, Lille, France.
| | - Yves Borghesi
- Department of Gynecologic Oncology, Oscar Lambret Cancer Center, Lille, France
| | - Delphine Hudry
- Department of Gynecologic Oncology, Oscar Lambret Cancer Center, Lille, France
| | - Julie Faes
- Department of Gynecologic Oncology, Oscar Lambret Cancer Center, Lille, France
| | - Lucie Bresson
- Department of Gynecologic Oncology, Oscar Lambret Cancer Center, Lille, France
| | - Fabrice Narducci
- Department of Gynecologic Oncology, Oscar Lambret Cancer Center, Lille, France
| | - Eric Leblanc
- Department of Gynecologic Oncology, Oscar Lambret Cancer Center, Lille, France
| |
Collapse
|
14
|
Torng PL, Pan SP, Hwang JS, Shih HJ, Chen CL. Learning curve in concurrent application of laparoscopic and robotic-assisted hysterectomy with lymphadenectomy in endometrial cancer. Taiwan J Obstet Gynecol 2017; 56:781-787. [DOI: 10.1016/j.tjog.2017.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2017] [Indexed: 10/18/2022] Open
|
15
|
Wisner KPA, Ahmad S, Holloway RW. Indications and techniques for robotic pelvic and para-aortic lymphadenectomy with sentinel lymph node mapping in gynecologic oncology. Best Pract Res Clin Obstet Gynaecol 2017; 45:83-93. [DOI: 10.1016/j.bpobgyn.2017.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 03/17/2017] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
|
16
|
Gucer F, Misirlioglu S, Ceydeli N, Taskiran C. Robot-assisted laparoscopic transperitoneal infrarenal lymphadenectomy in patients with locally advanced cervical cancer by single docking: Do we need a backup procedure? J Robot Surg 2017; 12:49-58. [DOI: 10.1007/s11701-017-0685-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/12/2017] [Indexed: 10/20/2022]
|
17
|
Ekdahl L, Salehi S, Falconer H. Improving Double Docking for Robot-assisted Para-aortic Lymphadenectomy in Endometrial Cancer Staging: Technique and Surgical Outcomes. J Minim Invasive Gynecol 2016; 23:818-24. [DOI: 10.1016/j.jmig.2016.03.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 11/24/2022]
|
18
|
Bougherara L, Blache G, Arsène E, Jauffret C, Azaïs H, Laplane C, Hudry D, Atrous G, Knight S, Bresson L, Kakkos A, Narducci F, Leblanc E, Houvenaeghel G, Bats AS, Lécuru F, Collinet P, Marchal F, Lambaudie E. La chirurgie robotique en oncogynécologie. ONCOLOGIE 2016. [DOI: 10.1007/s10269-016-2627-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
19
|
Robotic Transperitoneal Infrarenal Para-Aortic Lymphadenectomy With Double Docking: Technique, Learning Curve, and Perioperative Outcomes. J Minim Invasive Gynecol 2016; 23:622-7. [DOI: 10.1016/j.jmig.2016.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 11/17/2022]
|
20
|
Bogani G, Ditto A, Martinelli F, Signorelli M, Chiappa V, Sabatucci I, Scaffa C, Lorusso D, Raspagliesi F. Extraperitoneal Robotic-Assisted Para-Aortic Lymphadenectomy in Gynecologic Cancer Staging: Current Evidence. J Minim Invasive Gynecol 2016; 23:489-96. [PMID: 26802906 DOI: 10.1016/j.jmig.2016.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 01/14/2016] [Accepted: 01/14/2016] [Indexed: 11/29/2022]
Abstract
We reviewed the current evidence on the safety, effectiveness, and applicability of extraperitoneal robotic-assisted para-aortic lymphadenectomy (ExtRA-PAL) as the staging procedure of gynecologic malignancies. PubMed (MEDLINE), Scopus, Web of Science databases, and ClinicalTrials.gov were searched for original studies reporting outcomes of ExtRA-PAL. Quality of the included studies and their level of recommendation were assessed using the Grading of Recommendations, Assessment, Development, and Evaluation and the American College of Obstetricians and Gynecologists guidelines, respectively. Overall, 62 studies were identified; after a process of evidence acquisition 5 original investigations were available for this review that included 98 patients undergoing ExtRA-PAL. The main surgical indication was staging for cervical cancer (n = 71, 72%). The mean (SD) number of para-aortic node yielded was 15.4 (±4.7) nodes. Blood transfusion and intraoperative complication rates were 2% and 6%, respectively. ExtRA-PAL was completed in 88 patients (90%). Six (6%) and 4 (4%) patients had conversion to other minimally invasive procedures and open surgery, respectively. Success rate was 99% among patients undergoing ExtRA-PAL without concomitant procedures. Overall, mean (SD) length of hospital stay was 2.8 (±0.5) days. Twenty-four patients (24%) developed postoperative events. According to the Clavien-Dindo grading system, grades IIIa and IIIb morbidity rates were 12% and 2%, respectively. No grades IV and V morbidity occurred. ExtRA-PAL is associated with a high success rate and a relative low morbidity rate. However, because of the limited data on this issue, further studies are warranted to assess the long-term effectiveness of this procedure.
Collapse
Affiliation(s)
- Giorgio Bogani
- Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy.
| | - Antonino Ditto
- Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Fabio Martinelli
- Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Mauro Signorelli
- Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Valentina Chiappa
- Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Ilaria Sabatucci
- Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Cono Scaffa
- Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Domenica Lorusso
- Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | | |
Collapse
|
21
|
Lavoué V, Gotlieb W. Benefits of Minimal Access Surgery in Elderly Patients with Pelvic Cancer. Cancers (Basel) 2016; 8:cancers8010012. [PMID: 26771641 PMCID: PMC4728459 DOI: 10.3390/cancers8010012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 12/10/2015] [Accepted: 01/05/2016] [Indexed: 12/12/2022] Open
Abstract
An increasing proportion of patients requiring treatment for malignancy are elderly, which has created new challenges for oncologic surgeons. Aging is associated with an increasing prevalence of frailty and comorbidities that may affect the outcome of surgical procedures. By decreasing complications and shortening length of hospital stay without affecting oncologic safety, surgery performed using the robot, rather than traditional laparotomy, improves the chances of a better outcome in our growing elderly populations. In addition to age, surgeons should take into account factors, such as frailty and comorbidities that correlate with outcome.
Collapse
Affiliation(s)
- Vincent Lavoué
- Service de chirurgie gynécologique, Centre Hospitalo-Universitaire de Rennes, Hôpital Sud, 16 Bd de Bulgarie, 35000 Rennes, France.
- Inserm, ER440-OSS, CRLCC Eugène Marquis, Avenue Bataille Flandre-Dunkerque, 35000 Rennes, France.
| | - Walter Gotlieb
- Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
| |
Collapse
|
22
|
Extraperitoneal Para-aortic Lymphadenectomy by Robot-Assisted Laparoscopy in Gynecologic Oncology. Int J Gynecol Cancer 2015; 25:1494-502. [DOI: 10.1097/igc.0000000000000504] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
|
23
|
Extraperitoneal Lymphadenectomy in the Management of Gynecologic Cancer. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2015. [DOI: 10.1007/s13669-015-0124-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
24
|
Wisner KPA, Gupta S, Ahmad S, Holloway RW. Indications and techniques for robotic pelvic and para-aortic lymphadenectomy in gynecologic oncology. J Surg Oncol 2015; 112:782-9. [DOI: 10.1002/jso.24005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 07/27/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Ketura Preya A. Wisner
- Florida Hospital Gynecologic Oncology; Florida Hospital Cancer Institute and the Global Robotics Institute; Orlando Florida
- University of Central Florida College of Medicine; Orlando Florida
| | - Sarika Gupta
- Florida Hospital Gynecologic Oncology; Florida Hospital Cancer Institute and the Global Robotics Institute; Orlando Florida
| | - Sarfraz Ahmad
- Florida Hospital Gynecologic Oncology; Florida Hospital Cancer Institute and the Global Robotics Institute; Orlando Florida
- University of Central Florida College of Medicine; Orlando Florida
- Florida State University College of Medicine; Orlando Florida
| | - Robert W. Holloway
- Florida Hospital Gynecologic Oncology; Florida Hospital Cancer Institute and the Global Robotics Institute; Orlando Florida
- University of Central Florida College of Medicine; Orlando Florida
- Florida State University College of Medicine; Orlando Florida
| |
Collapse
|
25
|
Iavazzo C, Gkegkes ID. Robotic retroperitoneal lymph node dissection in gynaecological neoplasms: comparison of extraperitoneal and transperitoneal lymphadenectomy. Arch Gynecol Obstet 2015; 293:11-28. [PMID: 26188777 DOI: 10.1007/s00404-015-3814-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 07/03/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The main aim of our study is to review the till now available literature data on the role of robotic retroperitoneal lymph node dissection in gynaecological cancers by comparing the extraperitoneal versus the transperitoneal approach. METHODS A thorough and systematic search was performed in electronic databases of PubMed and Scopus. RESULTS The extraperitoneal approach is described in 148 patients. The age of the patients ranged from 26 to 78 years. The indications included cervical, endometrial and ovarian carcinoma in 113, 22 and 12 patients, respectively. The operative time ranged between 45 and 410 min. The number of dissected lymph nodes ranged from 3 to 25, while only 13 of them were found to be positive. The mean estimated blood loss during the operation was 77 ml (range <50-200 ml). Seven cases were converted to open. The duration of hospital stay ranged from 2 to 14 days. The transperitoneal approach is described in 898 patients. The age of the patients ranged from 15 to 89 years. Cervical, endometrial and ovarian carcinomas were the principal neoplasias present in 248, 449 and 164 patients, respectively. The operative time ranged from 19 to 633 min. The number of dissected lymph nodes ranged from 1 to 54, while the total number of patients with positive lymph nodes dissected was 56 patients. The estimated blood loss during the operation varied between 20 and 1800 ml. Only 9 out of 898 patients were converted to open. The duration of hospital stay ranged from 1 to 40 days. CONCLUSION A reliable definition of the "kind" of lymphadenectomy used in each study is the first step in order to reach safe conclusions. The lack of comparative studies, especially the randomized ones, cannot help us draw any safe conclusion regarding both the clinical outcomes and the possibility of any superiority of these different approaches (extraperitoneal and transperitoneal).
Collapse
Affiliation(s)
- Christos Iavazzo
- Gynaecological Oncology Department, Christie Hospital, Manchester, UK. .,, 38, Seizani Str., Nea Ionia, 14231, Athens, Greece.
| | - Ioannis D Gkegkes
- First Department of Surgery, General Hospital of Attica "KAT", Athens, Greece
| |
Collapse
|