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Chen Y, Zheng Y, Chen S, Peng S. An advantageous technique for fertility sparing staging surgery of epithelial ovarian cancer with a single umbilical incision. Int J Gynecol Cancer 2023; 33:1471-1472. [PMID: 36822656 DOI: 10.1136/ijgc-2023-004284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Affiliation(s)
- Yu Chen
- Department of Gynecologic Oncology, West China Second University Hospital, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Ying Zheng
- Department of Gynecologic Oncology, West China Second University Hospital, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Sijing Chen
- Department of Gynecologic Oncology, West China Second University Hospital, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Shiyi Peng
- Department of Gynecologic Oncology, West China Second University Hospital, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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Peng S, Zheng Y, Yang F, Wang K, Chen S, Wang Y. The Transumbilical Laparoendoscopic Single-Site Extraperitoneal Approach for Pelvic and Para-Aortic Lymphadenectomy: A Technique Note and Feasibility Study. Front Surg 2022; 9:863078. [PMID: 35495753 PMCID: PMC9053588 DOI: 10.3389/fsurg.2022.863078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundNowadays, lymphadenectomy could be performed by the transperitoneal or extraperitoneal approach. Nevertheless, each approach has its own advantages and disadvantages. Under these circumstances, we developed a transumbilical laparoendoscopic single-site (TU-LESS) extraperitoneal approach for lymphadenectomy. In this research, the primary goal is to demonstrate the feasibility of the novel approach in systematic lymphadenectomy and present the surgical process step-by-step.MethodsBetween May 2020 and June 2021, patients who had the indications of systematic lymphadenectomy underwent lymphadenectomy via the TU-LESS extraperitoneal approach. This new approach was described in detail, and the clinical characteristics and surgical outcomes were collected and analyzed.ResultsEight patients with gynecological carcinoma were included in the research, including four with high-risk endometrial cancer and four with early-stage ovarian cancer. The TU-LESS extraperitoneal approach for pelvic and para-aortic lymphadenectomy was successfully performed in all patients without conversion. In all, a median of 26.5 pelvic lymph nodes (range 18–35) and 18.0 para-aortic lymph nodes (range 7–43) were retrieved. There was a median of 166.5 min of surgical time (range 123–205). Patients had speedy recoveries without complications. All patients had positive pain responses after surgery, as well as satisfactory cosmetic and body image outcomes.ConclusionOur initial experience showed that it is feasible to perform systematic lymphadenectomy with the TU-LESS extraperitoneal approach. And this new approach may provide a new measure or a beneficial supplement for lymphadenectomy in gynecologic cancer.
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Affiliation(s)
- Shiyi Peng
- Department of Gynecology, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetrics, Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Ying Zheng
- Department of Gynecology, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetrics, Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
- *Correspondence: Ying Zheng
| | - Fan Yang
- Department of Gynecology, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetrics, Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Kana Wang
- Department of Gynecology, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetrics, Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Sijing Chen
- Department of Gynecology, West China Second Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetrics, Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, China
| | - Yawen Wang
- Department of Obstetrics and Gynecology, Shanxi Bethune Hospital, Taiyuan, China
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Li KP, Deng XZ, Wu T. Surgical Outcomes of Transperitoneal Para-Aortic Lymphadenectomy Compared With Extraperitoneal Approach in Gynecologic Cancers: A Systematic Review and Meta-Analysis. Front Surg 2022; 8:779372. [PMID: 34993228 PMCID: PMC8724245 DOI: 10.3389/fsurg.2021.779372] [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: 09/18/2021] [Accepted: 11/18/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: The optimal surgical approach for para-aortic lymphadenectomy (PALND) in gynecologic cancers using minimally invasive surgery (laparoscopy or robotic-assisted) is controversial. This study summarizes the current evidence on the extraperitoneal (EP) approach and compares its perioperative, surgical outcomes, and complications to the transperitoneal (TP) approach in an updated meta-analysis. Methods: We performed a systematic search in PubMed, Embase, Web of Science, Cochrane Library database for randomized controlled trials (RCTs) and non-RCTs that compare EP to TP for PALND. The main outcomes included surgical, perioperative outcomes, and complications. The weighted mean difference (WMD) and odds ratio (OR) were applied for the comparison of continuous and dichotomous variables with 95% CIs. Three RCTs and 10 non-RCTs trials, including 2,354 patients were identified and enrolled in the meta-analysis. Results: A total of three RCTs and ten non-RCTs trials, including 2,354 patients were identified and enrolled in the meta-analysis. We reported similar results for EP and TP in terms of the hospital stay, estimated blood loss, blood transfusion, conversion to laparotomy, total operative time, and postoperative complications (Clavien grade ≥ 1 and Clavien grade ≥ 3). However, the PALND operative time (WMD -10.46 min, 95% CI -19.04, -1.88; p = 0.02) and intraoperative complications (OR 0.40, 95% CI 0.23, 0.69; p = 0.001) were less with EP. Also, more nodes were removed in EP compared with the TP (WMD 1.45, 95% CI 0.05, 2.86; p = 0.04). Conclusions: The EP approach did not show differences regarding surgical and perioperative parameters compared with the TP approach. However, the number of aortic nodes retrieved was higher. Furthermore, The PALND operative time and intraoperative complications were less in EP.
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Affiliation(s)
- Kun-Peng Li
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xian-Zhong Deng
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Tao Wu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
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Chen S, Zhou J, Zheng Y, Wang K, Yang X. Para-aortic and Right Obturator Lymphadenectomy for Surgical Staging of Advanced Cervical Cancer through the TU-LESS Extraperitoneal Approach. J Minim Invasive Gynecol 2020; 28:1140. [PMID: 33333236 DOI: 10.1016/j.jmig.2020.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/25/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To present an innovative transumbilical laparoendoscopic single-site (TU-LESS) extraperitoneal approach for lymphadenectomy in a patient with advanced cervical carcinoma. DESIGN Demonstration of the novel technique through video. SETTING In advanced cervical cancer, determining the status of the para-aortic lymph nodes is essential because extended-field radiologic therapy is recommended for a patient with positive para-aortic lymph nodes [1]. Nonetheless, the sensitivity and specificity of currently available imaging workup for positive lymph nodes are limited. Surgical staging enables precise evaluation. However, laparotomy has potential wound complications and leads to treatment delay. Multiport laparoscopic transperitoneal and extraperitoneal approaches limit surgeons' ability to reach the para-aortic area or obturator fossa in the same operation [2]. Thus, we take full use of these approaches' advantages and avoid their disadvantages to design a promising minimally invasive surgery approach [3]. INTERVENTIONS Para-aortic and obturator lymphadenectomy through the TU-LESS extraperitoneal approach was successfully performed without complications. The patient recovered quickly and received subsequent concurrent chemoradiation on schedule. CONCLUSION TU-LESS extraperitoneal para-aortic lymphadenectomy provides satisfactory exposure and easy access to both the para-aortic area and obturator fossa. In addition, the bowels are uplifted by an extraperitoneal air cushion to achieve excellent exposure and reduce the risk of bowel injury. With quick recovery, the patient could start accurate radiation treatment promptly.
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Affiliation(s)
- Sijing Chen
- the Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education (all authors); Department of Gynecologic Oncology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China (all authors)
| | - Junying Zhou
- the Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education (all authors); Department of Gynecologic Oncology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China (all authors)
| | - Ying Zheng
- the Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education (all authors); Department of Gynecologic Oncology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China (all authors).
| | - Kana Wang
- the Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education (all authors); Department of Gynecologic Oncology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China (all authors)
| | - Xu Yang
- the Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education (all authors); Department of Gynecologic Oncology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, China (all authors)
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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]
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Lelievre L, Mathevet P. Para-aortic Lymphadenectomy for Gynecologic Cancers: Introducing the “Trans-Retro-Peritoneal (TRP) Single-Port Access”. Ann Surg Oncol 2019; 26:2540-2541. [DOI: 10.1245/s10434-019-07379-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Indexed: 11/18/2022]
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