8136 Robotic Interval Debulking with Radical Hysterectomy and Partial Urinary Bladder Resection for Locally Advanced Uterine Carcinosarcoma

Abstract

<h3>Study Objective</h3> Demonstrate an interval debulking where meticulous retroperitoneal dissection, ureterolysis and intentional cystotomy with ureteral stenting were performed robotically in a patient with large volume uterine carcinosarcoma to avoid pelvic exenteration. <h3>Design</h3> Demonstration of robotic radical hysterectomy, retroperitoneal dissection, ureterolysis, and intentional cystotomy with ureteral stenting. <h3>Setting</h3> Tertiary referral center in New Haven, Connecticut. <h3>Patients or Participants</h3> Surgical video case presentation. <h3>Interventions</h3> 47-year-old with locally advanced uterine carcinosarcoma underwent neoadjuvant chemotherapy with TAP (paclitaxel, doxorubicin, and cisplatin), followed by an interval debulking surgery. The uterus was enlarged with lower uterine segment tumor replacing the majority of the ectocervix. The posterior supratrigonal wall of the urinary bladder was extensively involved with the tumor. Extensive ureterolysis was performed from above the pelvic brim to the ureterovesical junctions in order to safely lateralize bilateral ureters. Tedious bladder dissection was performed to prevent thermal injury. A modified (Type B) radical hysterectomy was performed, sacrificing the bladder pillars, distal ureterosacral ligaments, and 2 cm of upper vagina. The posterior urinary bladder wall had clinically questionable residual tumor, therefore intentional cystotomy was performed to resect the involved segment. Six French, 24 cm double-J stents were placed to decrease the risk of ureteral fistula and stricture, given anticipation of postoperative pelvic radiation. The bladder was repaired in two layers. The patient was discharged home on postoperative day 2, and received adjuvant chemotherapy and vaginal brachytherapy, per tumor board recommendations. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> Locally advanced uterine carcinosarcoma can be managed on an individualized basis with neoadjuvant therapy followed by non-exenterative interval laparoscopic/robotic radical surgery, with emphasis on quality-of-life.