1
|
Sun J, Jiao X, Wu Z, Yao T, Tuo S, Wang Y, Chen R, He J, Qian J, Xu S, Liu Q. Intraperitoneal spread in uterine sarcoma following unprotected laparoscopic transvaginal uterine morcellation: a case report and literature review. Front Oncol 2024; 14:1434720. [PMID: 39188684 PMCID: PMC11345641 DOI: 10.3389/fonc.2024.1434720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 07/24/2024] [Indexed: 08/28/2024] Open
Abstract
Clinically and through auxiliary examinations, distinguishing uterine leiomyoma from early-stage uterine sarcoma presents significant challenges. A 48-year-old patient underwent a laparoscopic hysterectomy for uterine leiomyoma, during which a large uterus was excised through the vagina and extracted. Four months post-operation, the patient developed abdominal distension, indicative of extensive pelvic-abdominal dissemination of uterine sarcoma. We hypothesize that unprotected fibroid fragmentation increases the risk of uterine sarcoma spread, thereby worsening the prognosis. Our literature review aims to thoroughly understand the risks associated with unprotected transvaginal laparoscopic tumor division.
Collapse
Affiliation(s)
- Jianhao Sun
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China
| | - Xinjuan Jiao
- Qingyang Second People’s Hospital, Qingyang, Gansu, China
| | - Zhenzhen Wu
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| | - Tingting Yao
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| | - Shumei Tuo
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| | - Yueyuan Wang
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| | - Ruirong Chen
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| | - Jing He
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| | - Jifang Qian
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| | - Shengfang Xu
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| | - Qing Liu
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| |
Collapse
|
2
|
Outcomes of robotically assisted laparoscopic lateral suspension (RALLS) with mesh for anterior and apical prolapse. J Robot Surg 2021; 16:287-294. [PMID: 33821406 PMCID: PMC8960596 DOI: 10.1007/s11701-021-01234-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/29/2021] [Indexed: 12/11/2022]
Abstract
Abdominal sacral colpopexy/hysteropexy is the gold standard for the treatment of vaginal apex support. However, dissection of the promontory may expose to potentially life-threatening complications. To avoid this risk, laparoscopic lateral suspension with mesh is an alternative. Robotic assistance may be helpful in both techniques. The objective of our study was to evaluate outcomes of robotically assisted laparoscopic lateral suspension (RALLS) with mesh for anterior and apical pelvic organ prolapse (POP). From March 2012 to January 2018, 59 consecutive patients underwent RALLS using titanized polypropylene mesh. Between August 2017 and September 2019, all patients were contacted to assess outcome. We performed a clinical exam and asked them to complete the patient global impression of improvement (PGI-I) questionnaire. Fifty-four patients (91.5%) were available for follow-up. Mean age was 58.5 years (28.8-79.8). There were no perioperative complications. The mean follow-up was 33.6 months (11.2-74.1).The objective cure rate (no prolapse beyond hymen) and the subjective cure rate (PGI-I ≤ 2) were 83.3% and 77.2%, respectively. Five women (9.3%) were reoperated for POP recurrence. There was no erosion. Of the 20 women complaining of stress urinary incontinence (SUI) preoperatively, 12 (60%) were cured without any additional SUI procedure. Only two women (10%) required TVT for persistent grade 2 SUI. Two women (5.9%) developed de novo SUI, but none of them required an operation. RALLS repair for POP with mesh is safe and effective and may represent an alternative to sacral colpopexy/hysteropexy.
Collapse
|
3
|
Ebner F, Wiedenmann S, Bekes I, Wolfgang J, de Gregorio N, de Gregorio A. Results of an internal audit on the survival of patients with uterine sarcoma. J Turk Ger Gynecol Assoc 2018; 20:15-22. [PMID: 30299262 PMCID: PMC6501862 DOI: 10.4274/jtgga.galenos.2018.2018.0083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective: In the last 5 years there has been much discussion about the surgical procedure for uterine fibroids, and essentially, also uterine sarcoma. Still there exists no reliable presurgical diagnostic tool to differentiate between benign fibroids and uterine sarcomas. The aim of this study was to confirm the suspected association between intraoperative spread of tumor by morcellation and impaired outcomes in patients with sarcoma. Material and Methods: After the local ethics commission positively reviewed the study protocol, the oncologic database of our university hospital was retrospectively reviewed for patients with uterine sarcomas over a time period of 13 years (2002-2015). Data was extracted from the medical files and survival information was collected by contacting the patient’s general practitioners if last follow-up-status was older than 6 months. For the analysis, patients were split into two groups with either intrasurgical morcellation (M+) or no morcellation (M-) regarding information provided by the surgical report. Results: Data on 57 patients with uterine sarcoma were available for further analysis. The median age and body mass index of the patients was 63 years and 27 kg/m², respectively. The sarcoma subtypes were 25 leiomyosarcoma, 19 carcinosarcoma, 9 endometrioid stroma sarcoma, 3 adenosarcoma, and one case without further differentiation. In the majority, no morcellation was performed (M- group, n=44) and 51 patients received open surgery (3 laparoscopic, 1 vaginal, and 2 incomplete surgeries). The median time of follow-up was 31 months. The disease-free survival was 50.5 months and the Cox regression analysis showed a hazard ratio of 3.06 [no significant difference between the two subgroups (p=0.079; 95% confidence interval (CI): 0.9-10.6)]. The overall survival was found as 62.2 months and the Cox regression analysis showed a hazard ratio of 3.216 with a statistically significant difference between the two subgroups (p=0.013; 95% CI: 1.3-8.1). Conclusion: Despite the efforts to find a pre-surgical diagnostic tool, the clinical situation remains unsatisfactory. Overall sarcoma prevalence is low during the last 13 years at our university center, but morcellation occurred in a relevant portion of patients (13 of 57). If sarcoma is suspected or diagnosed then en-bloc resection of the uterus can prolong survival. Thus, morcellation of the uterus and not the surgical technique (en-bloc resection) is the prognostic factor and should be avoided in any suspicious case.
Collapse
Affiliation(s)
- Florian Ebner
- Frauenklinik, HELIOS Amper Klinikum, Dachau, Germany
| | - Saskia Wiedenmann
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Ulm, Ulm, Germany
| | - Inga Bekes
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Ulm, Ulm, Germany
| | - Janni Wolfgang
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Ulm, Ulm, Germany
| | | | - Amelie de Gregorio
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Ulm, Ulm, Germany
| |
Collapse
|
4
|
Wong AWY, Tsaltas J, Manley TR, Ratner RT, Yim CCM, Barel O. Unsuspected uterine sarcomas undergoing morcellation: A retrospective multicenter study. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2018. [DOI: 10.1177/2284026517748554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective: To evaluate the prevalence of unsuspected uterine sarcomas undergoing morcellation at the time of hysterectomy or myomectomy. Design: A retrospective cohort study. Settings: A teaching health service in Melbourne, Australia, consisting of four hospitals which provide gynecology and gynecology oncology services including one tertiary referral center. Population: All women undergoing any form of hysterectomy or myomectomy from 1998 to 2016. Methods: Patient demographics and the presence of morcellation were collected. All cases of confirmed uterine sarcomas were further examined and their histological subtype, patient demographics, preoperative investigations, and surgical indication were also identified. Results: A total of 7584 cases were studied. Overall, 33 uterine sarcomas were identified. Of these, seven cases were unsuspected malignancies. All seven cases were leiomyosarcomas. None of the malignant specimens underwent morcellation. The overall prevalence of uterine sarcomas in the total study population was 0.44%. The rate of unsuspected uterine sarcomas in women undergoing hysterectomy or myomectomy for presumed benign indications was 0.13% or 1 in 769. The rate of unintended morcellation of a uterine sarcoma in our center was 0%. The diagnosis of endometrial sarcoma was prompted by endometrial sampling in 58% of the cases when performed. Conclusion: The risk of inadvertent morcellation of unsuspected uterine sarcomas is low. Patients should be appropriately selected with adequate investigations and a detailed history and examination prior to surgery. Further studies are needed to identify effective preoperative screening methods for uterine sarcomas.
Collapse
Affiliation(s)
- Avelyn WY Wong
- Women’s and Children’s Program, Monash Health, Clayton, VIC, Australia
- Department of Obstetrics and Gynecology, Mercy Health, Heidelberg, VIC, Australia
| | - Jim Tsaltas
- Women’s and Children’s Program, Monash Health, Clayton, VIC, Australia
- Melbourne IVF, East Melbourne, VIC, Australia
| | - Tom R Manley
- Women’s and Children’s Program, Monash Health, Clayton, VIC, Australia
- Melbourne IVF, East Melbourne, VIC, Australia
| | - Roni T Ratner
- Women’s and Children’s Program, Monash Health, Clayton, VIC, Australia
| | - Cheryl CM Yim
- Women’s and Children’s Program, Monash Health, Clayton, VIC, Australia
| | - Oshri Barel
- Women’s and Children’s Program, Monash Health, Clayton, VIC, Australia
- Gynaecological Endoscopy Unit, Monash Health, Bentleigh East, VIC, Australia
| |
Collapse
|
5
|
Gupta N, Mohling S, Mckendrick R, Elkattah R, Holcombe J, Furr RS, Boren T, DePasquale S. Perioperative outcomes of robotic hysterectomy with mini-laparotomy versus open hysterectomy for uterus weighing more than 250 g. J Robot Surg 2018; 12:641-645. [PMID: 29453729 DOI: 10.1007/s11701-018-0792-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/12/2018] [Indexed: 11/25/2022]
Abstract
To compare perioperative outcomes in patients undergoing robotic hysterectomy and extraction of specimen via mini-laparotomy (RHML) versus open hysterectomy (OH) when uterus weighs more than 250 g. To study the factors determining the length of hospital stay in 2 groups. A retrospective analysis of all hysterectomies performed for uterus weighing more than 250 g from the year 2012 to 2015 was conducted. A total of 140 patients were divided into 2 groups based on the type of surgery; RHML (n = 82) and OH (n = 58). Mini-laparotomy consisted of a customised incision connecting 2 left lateral port sites for specimen extraction after completing the hysterectomy robotically. Patient factors and perioperative outcomes were compared using Student's t tests and Chi-square analysis. Mean length of stay (RHML = 1.4 days; OH = 3.4 days), estimated blood loss (EBL) (RHML = 119.9 ml; OH = 547.5 ml) and operative time (RHML = 191.5 min; OH = 162.8 min) were significantly different. No significant differences were noted for patient BMI, age, comorbidities, intraoperative complications, pathology of uterus and uterus weight. Postoperative complications were significantly different between two groups (RHML = 6.0%; OH = 15.5%; p = .021). None of the patients stayed less than 24 h in OH group compared to 59.8% patients in RHML group. Type of procedure (p = .004) and EBL (p = .002) significantly predicted the length of stay. Patients undergoing RHML have significantly shorter length of stay, EBL and postoperative complications than OH. The operative time for RHML was longer than OH, but the overall decreased length of stay overcomes this disadvantage. RHML approach retains the benefits of da Vinci, while simultaneously preserving the specimen.
Collapse
Affiliation(s)
- Natasha Gupta
- Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, TN, 37403, USA.
- Dept. of Obstetrics and Gynecology, Erlanger Health System, 979 E. 3rd Street, Suite C720, Chattanooga, TN, 37403, USA.
| | - Shanti Mohling
- Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, TN, 37403, USA
| | - Rebecca Mckendrick
- Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, TN, 37403, USA
- Department of Gynecologic Oncology, University of Tennessee College of Medicine, Chattanooga, TN, 37403, USA
| | - Rayan Elkattah
- Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, TN, 37403, USA
| | - Jenny Holcombe
- Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, TN, 37403, USA
- Department of Gynecologic Oncology, University of Tennessee College of Medicine, Chattanooga, TN, 37403, USA
| | - Robert S Furr
- Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of Tennessee College of Medicine, Chattanooga, TN, 37403, USA
| | - Todd Boren
- Department of Gynecologic Oncology, University of Tennessee College of Medicine, Chattanooga, TN, 37403, USA
| | - Stephen DePasquale
- Department of Gynecologic Oncology, University of Tennessee College of Medicine, Chattanooga, TN, 37403, USA
| |
Collapse
|
6
|
Clark NV, Cohen SL. Tissue Extraction Techniques During Laparoscopic Uterine Surgery. J Minim Invasive Gynecol 2017; 25:251-256. [PMID: 28866098 DOI: 10.1016/j.jmig.2017.07.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 10/18/2022]
Abstract
Morcellation allows minimally invasive approaches to surgery even in the presence of large uteri or myomas. Recent restrictions in the use of power morcellation, as well as concerns regarding the potential for morcellation to disseminate malignant tissue, have initiated investigation and innovation to find safer methods. This review examines current techniques for tissue extraction during uterine surgery, with a focus on contained power morcellation and contained manual morcellation via mini-laparotomy or colpotomy. Videos are included to demonstrate these methods.
Collapse
Affiliation(s)
- Nisse V Clark
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sarah L Cohen
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
| |
Collapse
|
7
|
Sarcoma Risk in Uterine Surgery in a Tertiary University Hospital in Germany. Int J Gynecol Cancer 2017; 27:961-966. [DOI: 10.1097/igc.0000000000000988] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
8
|
Cohen A, Tulandi T. Long-term sequelae of unconfined morcellation during laparoscopic gynecological surgery. Maturitas 2017; 97:1-5. [DOI: 10.1016/j.maturitas.2016.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 11/13/2016] [Accepted: 11/14/2016] [Indexed: 12/12/2022]
|
9
|
Abstract
BACKGROUND AND OBJECTIVES The well-known advantages of minimally invasive surgery make the approach well suited for hysterectomy and other gynecological procedures. The removal of specimens excised during surgery has been a challenge that has been answered by the use of power morcellation. With this study we sought to assess the feasibility of power morcellation within a specimen bag. METHODS This was a retrospective cohort study including patients from a private practice in suburban Chicago, Illinois, who underwent contained electromechanical power morcellation during a laparoscopic or robot-assisted hysterectomy or myomectomy from May 2014 through December 2015. Contained power morcellation was performed with the Espiner EcoSac 230 (Espiner Medical Ltd., North Somerset, United Kingdom) specimen bag. Descriptive statistics were performed for both categorical and continuous data. RESULTS Of the 187 procedures performed, 73.8% were myomectomies, and 26.2% were hysterectomies. The patients' mean age was 40 (range, 25-54) years and mean body mass index was 28.7 (range, 17.3-57.6). The average specimen weight was 300 g, with the largest weighing 2134 g. Estimated blood loss averaged 98.4 mL. The postoperative admission rate was 12.3%, most of which were due to nausea and urinary retention. Seventeen patients (9.1%) had postoperative complications, most of which were minor, and 4 (2.1%) were readmitted. There were no bag failures or complications that were due to the use of the specimen bag or to power morcellation. CONCLUSIONS Performing electromechanical power morcellation within the Espiner EcoSac 230 specimen bag was successfully performed in 187 patients with no bag-related complications. This method of contained power morcellation is feasible, reliable, and reproducible, even for a large specimen.
Collapse
Affiliation(s)
| | - Aarathi Cholkeri-Singh
- Minimally Invasive Gynecology, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | | | - Charles E Miller
- Minimally Invasive Gynecology, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| |
Collapse
|
10
|
Raspagliesi F, Maltese G, Bogani G, Fucà G, Lepori S, De Iaco P, Perrone M, Scambia G, Cormio G, Bogliolo S, Bergamini A, Bifulco G, Casali PG, Lorusso D. Morcellation worsens survival outcomes in patients with undiagnosed uterine leiomyosarcomas: A retrospective MITO group study. Gynecol Oncol 2017; 144:90-95. [DOI: 10.1016/j.ygyno.2016.11.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/26/2016] [Accepted: 11/01/2016] [Indexed: 11/26/2022]
|
11
|
|
12
|
Total Laparoscopic Hysterectomy in Patients with Large Uteri: Comparison of Uterine Removal by Transvaginal and Uterine Morcellation Approaches. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8784601. [PMID: 27419141 PMCID: PMC4933852 DOI: 10.1155/2016/8784601] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/20/2016] [Indexed: 12/18/2022]
Abstract
The aim of this study was to compare the clinical results of total laparoscopic hysterectomy (TLH) for large uterus with uterus size of 12 gestational weeks (g.w.) or greater through transvaginal or uterine morcellation approaches. We retrospectively collected the clinical data of those undergoing total laparoscopic hysterectomies between January 2004 and June 2012. Intraoperative and postoperative outcomes were compared between patients whose large uterus was removed through transvaginal or morcellation approaches. The morcellation group has significantly shorter mean operation time and uterus removal time and smaller incidence of intraoperative complications than the transvaginal group (all P < 0.05). No statistical significant difference regarding the mean blood loss, uterine weight, and length of hospital stay was noted in the morcellation and transvaginal groups (all P > 0.05). In two groups, there was one patient in each group who underwent conversion to laparotomy due to huge uterus size. With regard to postoperative complications, there was no statistical significant difference regarding the frequencies of pelvic hematoma, vaginal stump infection, and lower limb venous thrombosis in two groups (all P > 0.05). TLH through uterine morcellation can reduce the operation time, uterus removal time, and the intraoperative complications and provide comparable postoperative outcomes compared to that through the transvaginal approaches.
Collapse
|
13
|
|
14
|
Noel NL, Isaacson KB. Morcellation complications: From direct trauma to inoculation. Best Pract Res Clin Obstet Gynaecol 2015; 35:37-43. [PMID: 26879674 DOI: 10.1016/j.bpobgyn.2015.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 12/30/2022]
Abstract
Morcellation is the fragmentation of tissue to facilitate removal of the specimen through small incision in minimally invasive surgery. This technique is not unique to gynecology and is used in general surgery with the goal of improved surgical outcomes including decreased pain, cost, hospital length of stay, and rapid return to normal activities and work. Gynecologic laparoscopic power morcellation (LPM) has come under increased scrutiny over the last 2 years due to widespread attention to a known but rare complication, an unanticipated dissemination of malignancy, namely occult uterine leiomyosarcoma. This chapter focuses on complications associated with gynecologic tissue morcellation from inoculation of benign or malignant tissue fragments within the peritoneal cavity and direct trauma from morcellation techniques. We also include a review of the various morcellation techniques from knife to electrical and the use of intraperitoneal specimen containment systems.
Collapse
Affiliation(s)
- Nyia L Noel
- Newton-Wellesley Hospital, Harvard Medical School, Newton, MA, USA.
| | - Keith B Isaacson
- Newton-Wellesley Hospital, Harvard Medical School, Newton, MA, USA.
| |
Collapse
|
15
|
First clinical experiences using a new in-bag morcellation system during laparoscopic hysterectomy. Arch Gynecol Obstet 2015; 294:83-93. [PMID: 26690354 DOI: 10.1007/s00404-015-3986-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 12/08/2015] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Endoscopic techniques have successfully reduced the invasiveness of hysterectomy, when compared to open procedures. Power morcellation, as a part of the minimal invasive concept, carries the risk of disseminating cells from the tissue specimen. The present observational study reports on first experiences using a new system (More-Cell-Safe, A.M.I., Austria) for contained in-bag morcellation during laparoscopic hysterectomy. MATERIALS AND METHODS The dual opening system allows two-port access without bag puncture. The optic is protected against spread cell contamination with a disposable sleeve. Application data were prospectively recorded on the first n = 7 consecutive patients and compared to n = 7 preceding patients undergoing uncontained morcellation. RESULTS Bag system use was surgically successful in 6 of 7 cases (85.7 %). Morcellated specimen weight ranged from 205 to 638 g (mean 413.33 ± 176.85; median 413). In one patient, the uterine specimen (1050 g) proved too large to be placed into the bag. Average time associated to the bag use was 16.2 ± 7.65 min, ranging from 8.5 to 26.5 min (median 14 min). Removed bags contained bloody fluid with residual tissue fragments weighing overall between 21 and 85 g. Spread spindle cells were detected in two cases after uncontained morcellation, but not after in-bag morcellation. CONCLUSION The experiences from our small pilot series prove technical feasibility in the clinical setting.
Collapse
|
16
|
Vaginal Morcellation Inside Protective Pouch: A Safe Strategy for Uterine Extration in Cases of Bulky Endometrial Cancers: Operative and Oncological Safety of the Method. J Minim Invasive Gynecol 2015; 22:938-43. [DOI: 10.1016/j.jmig.2015.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 04/16/2015] [Accepted: 04/16/2015] [Indexed: 12/28/2022]
|
17
|
Asmar J, Even M, Carbonnel M, Goetgheluck J, Revaux A, Ayoubi JM. Myomectomy by Robotically Assisted Laparoscopic Surgery: Results at Foch Hospital, Paris. Front Surg 2015; 2:40. [PMID: 26347871 PMCID: PMC4542131 DOI: 10.3389/fsurg.2015.00040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 07/31/2015] [Indexed: 11/16/2022] Open
Abstract
We reported an observational, retrospective chart review of 36 women who underwent robotic myomectomy at the Department of Obstetrics and Gynecology, Foch Hospital. Short- and long-term results were analyzed. We compared our results with literature data. Potential advantages and limits of robotic surgery in myomectomy are discussed.
Collapse
|
18
|
Taylor DK, Holthouser K, Segars JH, Leppert PC. Recent scientific advances in leiomyoma (uterine fibroids) research facilitates better understanding and management. F1000Res 2015; 4:183. [PMID: 26236472 PMCID: PMC4513689 DOI: 10.12688/f1000research.6189.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2015] [Indexed: 01/12/2023] Open
Abstract
Uterine leiomyomas (fibroids) are the most prevalent medical problem of the female reproductive tract, but there are few non-surgical treatment options. Although many advances in the understanding of the molecular components of these tumors have occurred over the past five years, an effective pharmaceutical approach remains elusive. Further, there is currently no clinical method to distinguish a benign uterine leiomyoma from a malignant leiomyosarcoma prior to treatment, a pressing need given concerns about the use of the power morcellator for minimally invasive surgery. This paper reviews current studies regarding the molecular biology of uterine fibroids, discusses non-surgical approaches and suggests new cutting-edge therapeutic and diagnostic approaches.
Collapse
Affiliation(s)
- Darlene K Taylor
- Department of Chemistry, North Carolina Central University, Durham, NC, 27707, USA
| | - Kristine Holthouser
- Department of Obstetrics and Gynecology, University of Louisville, Louisville, KY, USA
| | - James H Segars
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Phyllis C Leppert
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, 27710, USA
| |
Collapse
|
19
|
A new in-bag system to reduce the risk of tissue morcellation: development and experimental evaluation during laparoscopic hysterectomy. Arch Gynecol Obstet 2015; 292:1311-20. [PMID: 26093523 DOI: 10.1007/s00404-015-3788-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 06/08/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Minimal invasive approaches have proven beneficial for patients undergoing myomectomy and hysterectomy, but necessary tissue morcellation carries the risk of cell dissemination in rare cases of inadvertent malignancy. Performing the morcellation process within a contained bag system may prevent spilling and therefore enhance safety of the laparoscopic procedures. MATERIAL AND METHODS The present study describes the development and experimental evaluation of a new bag system in vitro and in vivo in a pig model of laparoscopic supracervical hysterectomies. RESULTS The main results on n = 8 procedures with in-bag morcellation compared to n = 8 controls without bag indicate reproducible feasibility and protective effect of the new bag, which is the first published to our knowledge that does not require puncturing in a standard multiport laparoscopy setting. Overall surgery time was significantly prolonged in the bag group by 12.86 min (P = 0.0052; 95 % confidence interval 4.64-21.07), but peritoneal washings were negative for muscle cells in all cases with bag use, compared to positive cytology in 5/8 cases without bag (P = 0.0256). CONCLUSION Clinical trials will now be necessary to investigate the reproducibility of these encouraging data in human application.
Collapse
|
20
|
Impact of morcellation on survival outcomes of patients with unexpected uterine leiomyosarcoma: A systematic review and meta-analysis. Gynecol Oncol 2015; 137:167-72. [DOI: 10.1016/j.ygyno.2014.11.011] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 11/08/2014] [Accepted: 11/14/2014] [Indexed: 11/18/2022]
|
21
|
Is open surgery the solution to avoid morcellation of uterine sarcomas? A systematic literature review on the effect of tumor morcellation and surgical techniques. Arch Gynecol Obstet 2015; 292:499-506. [DOI: 10.1007/s00404-015-3664-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 02/12/2015] [Indexed: 12/27/2022]
|
22
|
Robotic Surgery in Gynecologic Oncology: Updates and Innovations. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2014. [DOI: 10.1007/s13669-014-0101-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
23
|
Abstract
INTRODUCTION Pharmacological treatment plays a major role in the management of advanced, persistent or recurrent uterine leiomyosarcoma (LMS), whereas its usefulness in the adjuvant setting is still debated. A thorough literature search was undertaken using the Pubmed databases. Systematic reviews and controlled trials on medical treatment of uterine LMS were collected and critically analyzed. Other study types were secondarily considered when pertinent. AREAS COVERED Doxorubicin (DOX), ifosfamide and dacarbazine have been long used in the treatment of this malignancy. Novel active agents are represented by gemcitabine, docetaxel, trabectedin, pazopanib and aromatase inhibitors, whereas the role of eribulin, bevacizumab, aflibercept and mammalian target of rapamycin inhibitors is still investigational. EXPERT OPINION DOX alone, gemcitabine alone, DOX + dacarbazine and gemcitabine + docetaxel may be treatment options for first-line and second-line therapies. However, the clinical benefit of the combination chemotherapy versus single-agent chemotherapy is still debated. Trabectedin is a promising agent for recurrent uterine LMS, able to obtain a prolonged disease control, with 3-month and 6-month progression-free survival rates exceeding 50 and 30%, respectively, and with sometimes unexpectedly durable responses. Pazopanib is the only approved targeted therapy. Hormone therapy with aromatase inhibitors may be a therapeutic option in heavily treated patients with slowly progressive, steroid receptor-positive tumors. Whenever possible, women with recurrent uterine LMS should be encouraged to enter well-designed clinical trials aimed to detect novel active agents.
Collapse
Affiliation(s)
- Angiolo Gadducci
- University of Pisa, Division of Gynecology and Obstetrics, Department of Experimental and Clinical Medicine , Via Roma 56, Pisa, 56127 , Italy +39 50 992609 ; +39 50 992354 ;
| | | |
Collapse
|