Laparoscopic Purse-String Technique for Containment of Gynecologic Malignancy

Abstract

Study Objective The objective of this video is to demonstrate a robotic-assisted laparoscopically placed purse-string for containment of gynecologic malignancy. Design Step-by-step demonstration of a laparoscopic purse-string technique to create a vaginal cerclage and contain malignant tumor cells. Setting Academic tertiary referral center. Patients or Participants The patient was a 66-year-old female who presented with postmenopausal bleeding. After undergoing physical examination, biopsy of the tumor, and diagnostic imaging, she was ultimately diagnosed with endometrial cancer. Interventions The patient underwent a robotic-assisted, laparoscopic total hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic lymph node dissections, peri-aortic lymph node dissection, and distal omentectomy. Prior to the start of the laparoscopic procedure, methylene blue was injected in the vagina to delineate the most distal portion of the tumor. A purse-string suture was placed to create a vaginal cerclage abdominally prior to creation of colpotomy to help decrease tumor cell dissemination. Measurements and Main Results A purse-string suture was successfully placed to encapsulate tumor cells prior to colpotomy. The patient tolerated the procedure well and did not have any post-operative complications. Conclusion Placement of a purse-string suture laparoscopically is a feasible surgical technique to help minimize tumor dissemination. The objective of this video is to demonstrate a robotic-assisted laparoscopically placed purse-string for containment of gynecologic malignancy. Step-by-step demonstration of a laparoscopic purse-string technique to create a vaginal cerclage and contain malignant tumor cells. Academic tertiary referral center. The patient was a 66-year-old female who presented with postmenopausal bleeding. After undergoing physical examination, biopsy of the tumor, and diagnostic imaging, she was ultimately diagnosed with endometrial cancer. The patient underwent a robotic-assisted, laparoscopic total hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic lymph node dissections, peri-aortic lymph node dissection, and distal omentectomy. Prior to the start of the laparoscopic procedure, methylene blue was injected in the vagina to delineate the most distal portion of the tumor. A purse-string suture was placed to create a vaginal cerclage abdominally prior to creation of colpotomy to help decrease tumor cell dissemination. A purse-string suture was successfully placed to encapsulate tumor cells prior to colpotomy. The patient tolerated the procedure well and did not have any post-operative complications. Placement of a purse-string suture laparoscopically is a feasible surgical technique to help minimize tumor dissemination.