Laparoscopic Pelvic Node Research Articles

Dry Lab Training Model of Laparoscopic Lateral Pelvic Lymph Node Dissection for Rectal Cancer.

Dry Lab Training Model of Laparoscopic Lateral Pelvic Lymph Node Dissection for Rectal Cancer.

Laparoscopic lateral pelvic lymph node dissection combined with removal of the internal iliac vessels in rectal cancer: how to standardize this surgical procedure.

Lateral pelvic lymph node dissection (LLND) combined with removal of the internal iliac vessels is a challenging surgical procedure in minimally invasive surgery. We herein report our dissection approach and short-term outcomes. We conducted a study on rectal cancer patients who underwent laparoscopuic LLND combined with removal of the internal iliac vessels at our institution in March 2017-December 2019. In performing the surgery, we identified and dissected along the three pelvic sidewall fasciae (ureterohypogastric, umbilical prevesical and parietal pelvic fascia), located the internal ilial vein at the level of the common iliac vessels and carried out our dissection along the medial anterior surface of the internal iliac before transecting the vein.The duration of LLND was recorded as was the blood loss. There were 16 patients (10 males, mean age 65.4 ± 10.8years). Five patients had primary surgery, and 11 had surgery for recurrence. The median blood loss of LLND was 10ml (range, 0-250ml), the median operating time was 173min (range, 65-358min), and post-operative complications were relatively mild. Seven of 16 patients (43.8%) were diagnosed with positive lateral nodes. The 2-year local recurrence-free and disease-free survival rates were 87.5% and 58.0%. Recognizing the pelvic anatomical points illustrated in the present study contributes to the surgical safety of LLND combined with removal of the internal iliac vessels.

Long-term effects of laparoscopic lateral pelvic lymph node dissection on urinary retention in rectal cancer.

The addition of lateral pelvic lymph node dissection (LPLND) in rectal cancer surgery has been reported to increase the incidence of post-operative urinary retention. Here, we assessed the predictive factors and long-term outcomes of urinary retention following laparoscopic LPLND (L-LPLND) with total mesorectal excision (TME) for advanced lower rectal cancer. This retrospective single-institutional study reviewed post-operative urinary retention in 71 patients with lower rectal cancer who underwent L-LPLND with TME. Patients with preoperative urinary dysfunction or who underwent unilateral LPLND were excluded. Detailed information regarding patient clinicopathologic characteristics, post-void residual urine volume, and the presence or absence of urinary retention over time was collected from clinical and histopathologic reports and telephone surveys. Urinary retention was defined as residual urine > 100mL and the need for further treatment. Post-operative urinary retention was observed in 25/71 patients (35.2%). Multivariate analysis revealed that blood loss ≥ 400mL [odds ratio (OR) 4.52; 95% confidence interval (CI) 1.24-16.43; p = 0.018] and inferior vesical artery (IVA) resection (OR 8.28; 95% CI 2.46-27.81; p < 0.001) were independently correlated with the incidence of urinary retention. Furthermore, bilateral IVA resection caused urinary retention in more patients than unilateral IVA resection (88.9% vs 47.1%, respectively; p = 0.049). Although urinary retention associated with unilateral IVA resection improved relatively quickly, urinary retention associated with bilateral IVA resection tended to persist over 1year. We identified the predictive factors of urinary retention following L-LPLND with TME, including increased blood loss (≥ 400mL) and IVA resection. Urinary retention associated with unilateral IVA resection improved relatively quickly. L-LPLND with unilateral IVA resection is a feasible and safe procedure to improve oncological curability. However, if oncological curability is guaranteed, bilateral IVA resection should be avoided to prevent irreversible urinary retention.

Kết quả bước đầu vét hạch vùng chậu bên bằng phẫu thuật nội soi điều trị ung thư trực tràng thấp đã hóa xạ trị tiền phẫu

Tóm tắt Đặt vấn đề: Đánh giá tính khả thi, an toàn, hiệu quả của phẫu thuật nội soi nạo vét hạch vùng chậu bên (Lateral Pelvic Lymph Node Dissection- LPLD) điều trị ung thư trực tràng thấp đã được hóa xạ trị tiền phẫu dài ngày. Phương pháp nghiên cứu: Nghiên cứu tiến cứu ở người bệnh (NB) ung thư trực tràng thấp được điều trị hóa xạ trị tiền phẫu dài ngày kết hợp phẫu thuật nội soi LPLD tại Khoa Phẫu thuật Hậu môn Trực tràng, Bệnh viện Trung ương Quân đội (TƯQĐ) 108 từ tháng 7/2018 - 02/2020. Kết quả: 14 người bệnh (10 nam, 4 nữ), tuổi trung bình 56,3 ± 10,5 tuổi (28 - 70). 100% u nằm dưới nếp phúc mạc. Giai đoạn (GĐ) trước mổ có 85,7% T4; 14,3% T3, 100% N+. Có 100% NB được hóa xạ trị (HXT) dài ngày trước mổ. GĐ sau HXT có 64,3% T3; 35,7% T2, 100% N+. Khoảng cách bờ dưới u đến mép hậu môn 4,7 ± 0,9cm (3-7). Có 5 NB vét hạch 2 bên, 9 NB vét hạch 1 bên. Thời gian phẫu thuật trung bình 174,3 phút (140 - 200), số lượng máu mất 84,3 ml (35 -200). Thời gian trung bình nạo vét hạch chậu 36,8 phút (15 - 65 phút). Tỉ lệ tai biến trong mổ: 1 NB chảy máu do tổn thương tĩnh mạch chậu trong được khâu cầm máu trong mổ. Tỉ lệ biến chứng chung: 1 NB hẹp miệng nối. Thời gian nằm viện trung bình 10,2 ngày (5 – 17). Tổng số hạch nạo vét toàn bộ là 14,1 hạch (5 - 33). Hạch chậu vét được là 7,6 hạch (3 -22). Tỉ lệ di căn hạch chậu bên: 42,8%. GĐ sau mổ có 35,7% T3; 50,0% T2; 7,1% T1; 7,1% T0; 42,8% N+. Chức năng sinh dục, tiết niệu lần lượt dựa theo câu hỏi thang điểm IIEF, IPSS trước mổ và sau mổ có rối loạn mức độ nhẹ. Kết luận: Phẫu thuật nội soi nạo vét hạch vùng chậu bên điều trị ung thư trực tràng thấp là khả thi, an toàn. Chức năng sinh dục, tiết niệu ít ảnh hưởng. Abstract Introduction: Assessment of the feasibility, safety, effectiveness of lateral pelvic lymph node dissection (LPLD) for lower rectal cancer after preoperative chemoradiotherapy (CRT). Materials and Methods: This was a prospective cohort study of lower rectal cancer treated by laparoscopic lateral pelvic lymph node dissection after preoperative chemoradiotherapy at the Department of Colon and Rectal Surgery, 108 Military Central Hospital between July 2018 and February 2020. Results: Fourteen patients (10 men and 4 women), with a mean (s.d) age of 56.3 (10.5) years. 100% the tumor was extraperitoneal. Pre-operative stage was 85.7 % T4; 14.3% T3, 100% N+. 100% has CRT for long term. After CRT were 64.3% T3; 35.7% T2, 100% N+. The distance from tumors to anal verge was 4,7 0,9cm (3-7). Bilateral LPLD was in 5 cases, and unilateral in 9 cases. The mean operation time was 174.3 minutes (range, 140 – 200), mean operative blood loss 84.3 ml (range, 35 to 200). The duration time mean for lymph node dissection was 36.8 minutes (15 – 65). Pre-operative accident: 1 bleeding due to injury to internal iliac veins has repair during the operation, post-operative complication: 1 patient has anastomotic stenosis. The length stay mean was 10,2 days (5 -17). The mean number of harvested lymph nodes was 14.1 (5-33). The number of pelvic lymph nodes harvested was 7,6 (3-22). The rate of positive lateral lymph nodes was 42.8%. Postoperative stage was 35.7 % T3; 50.0% T2; 7.1% T1; 42.8% N1. The sexual function as well as urinary function were evaluated according to perioperative and postoperation by using standard questionnaires of the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function ( IIEF) showed a little disorder. Conclusion: The LPLD technique is feasible, safe, effective for lower rectal cancer after preoperative chemoradiotherapy. Keywords: Lateral Pelvic Lymph Node Dissection – LPLD, rectal cancer, preoperative chemoradiotherapy.

2070 A Case of Clear Cell Carcinoma Arising from Cystic Adenomyosis Treated with Laparoscopic Surgerya Case of Clear Cell Carcinoma Arising from Cystic Adenomyosis Treated with Laparoscopic Surgery

Study Objective Ovarian cancer arising from benign endometriotic has been widely reported. cystic adenomyoma is a rare form of adenomyosis. And clear cell carcinoma arising from cystic adenomyosis is even more unusual. Here we report a case of clear cell carcinoma arising from cystic adenomyosis treated with laparoscopic surgery. Design Case report. Setting A tertiary care hospital. Patients or Participants 41-years-old Japanese woman, gravida 4 paras 2. Two years ago, she was pointed out an index finger size cystic lesions in the uterine posterior wall. Interventions Laparoscopic surgery. Measurements and Main Results At her follow-up visit, she did not complain of any particular symptoms, but enlargement of the cystic lesion was pointed out by the transvaginal ultrasound. MRI was performed, and MRI findings revealed that the cystic lesion was cystic adenomyosis with a mural nodule in the cyst. Moreover, the nodule showed slight enhancement with contrast images and high-intensity on diffusion-weighted images in MRI. These findings were suspected malignancy. We performed laparoscopic hysterectomy. Postoperative pathological findings are adenomyosis with clear cell carcinoma within the mural nodule was diagnosed as clear cell carcinoma. We performed laparoscopic bilateral oophorectomy and pelvic lymph node dissection under the laparoscopic surgery as additional surgery. No residual tumor and metastasis was observed, and cytology of ascites was negative. Her final diagnosis was endometrial cancer stage IB, pT1BN0M0, since the nodule was in the outer half of the uterine myometrium. After the second surgery, she suffered from chylous ascites for three months. Adjuvant chemotherapy with paclitaxel and carboplatin was performed after ascites was disappeared. Conclusion Although carcinoma arising from cystic adenomyosis is rare, the enlargement or the appearance of nodules might be suspicious findings of carcinoma arising from cystic adenomyosis. And laparoscopic surgery was useful for diagnosis and treatment of this rare condition.

Long-term results of fertility-sparing treatment for early-stage cervical cancer

ObjectiveTo evaluate the long-term outcomes of young early stage cervical cancer patients wishing to preserve their childbearing potential. MethodsData of young (aged <40 years) patients with early stage cervical cancer were prospectively collected. All patients with stage IA2, IB1 and IB2 cervical cancer were included; they have cervical conization and pelvic node dissection performed via minimally invasive surgery. Survival outcomes were assessed with the Kaplan-Meier model. ResultsOverall, 32 patients met the inclusion criteria. Mean (SD) age of the population included was 33 (±4). According to the FIGO 2018 staging system, the stage of disease was IA2, IB1 and IB2 in 9 (28%), 21 (66%) and 2 (6%) cases, respectively. All patients included had cervical conization and laparoscopic pelvic node assessment, including systematic pelvic lymphadenectomy (N = 30, 94%) and sentinel node mapping (N = 2, 6%). In six (19%) patients the planned conservative treatment was discontinued. Median follow-up was 75 (range, 12–184) months. No recurrent disease was diagnosed among patients undergoing conservative treatment; while 2 out of 6 patients having definitive surgical or radiotherapy treatments developed recurrent disease. Five-year disease free and overall survivals were 94% and 97%, respectively. Considering reproductive outcomes, 11 (69%) out of 16 patients who attempted to conceive got pregnant. ConclusionsCervical conization and pelvic nodes assessment could be considered a valid treatment modality for early-stage cervical cancer patients who are wishing to preserve their childbearing potential.

The technique and impact of laparoscopic extended pelvic lymph node dissection in high-risk prostate carcinoma

The technique and impact of laparoscopic extended pelvic lymph node dissection in high-risk prostate carcinoma

Fertility Conserving Management of Early Cervical Cancer: Our Experience of LLETZ and Pelvic Lymph Node Dissection

Presently, for those diagnosed with early cervical cancer who wish to conserve their fertility, there is the option of radical trachelectomy. Although successful, this procedure is associated with significant obstetric morbidity. The recurrence risk of early cervical cancer is low and in tumors measuring less than 2 cm; if the lymphatics are negative, the likelihood of parametrial involvement is less than 1%. Therefore, pelvic lymph nodes are a surrogate marker of parametrial involvement and radical excision of the parametrium can be omitted if they are negative. The aim of this study was to report our experience of the fertility conserving management of early cervical cancer with repeat large loop excision of the transformation zone and laparoscopic pelvic lymph node dissection. Between 2004 and 2011, a retrospective review of cases of early cervical cancer who had fertility conserving management within Glasgow Royal Infirmary was done. Forty-three patients underwent fertility conserving management of early cervical cancer. Forty were screen-detected cancers; 2 were stage IA1, 4 were stage IA2, and 37 were stage IB1. There were 2 central recurrences during the follow-up period. There have been 15 live children to 12 women and there are 4 ongoing pregnancies. To our knowledge, this is the largest case series described and confirms the low morbidity and mortality of this procedure. However, even within our highly select group, there have been 2 cases of central recurrent disease. We, therefore, are urging caution in the global adoption of this technique and would welcome a multicenter multinational randomized controlled trial.

V21 Robotic-assisted laparoscopic extended pelvic lymph node dissection for prostate cancer: Usefulness of the fourth arm

V21 Robotic-assisted laparoscopic extended pelvic lymph node dissection for prostate cancer: Usefulness of the fourth arm

Perioperative nursing in patients with laparoscopic radical hysterectomy and pelvic lymph node dissection

Objective To discuss the nursing measures of patients with laparoscopic radical hysterectomy and pelvic lymph node dissection. Methods 24 patients with laparoscopic radical hysterecto my and pelvic lymph node dissection were selected and their perioperative nursing measures were summa rized. Results 24 patients were all cured and discharged, 6 patients accepted chemotherapy and 3 patients accepted radiotherapy. All patients were followed up, and they recovered well. Conclusions Perfect perioperative can guarantee early recovery of patients. Key words: Laparoscopy; Radical hysterectomy; Pelvic lymph node dissection; Nursing

A report of two cases of the management of cervical cancer in pregnancy by cone biopsy and laparoscopic pelvic node dissection

Please cite this paper as: Herod J, Decruze S, Patel R. A report of two cases of the management of cervical cancer in pregnancy by cone biopsy and laparoscopic pelvic node dissection. BJOG 2010;117:1558–1561.

74 Robot assisted laparoscopic extended pelvic lymph node dissection during radical cystoprostatectomy: Initial Ankara experience

74 Robot assisted laparoscopic extended pelvic lymph node dissection during radical cystoprostatectomy: Initial Ankara experience

Case Report: Loss of Hernia Mesh after Simultaneous Laparoscopic Extraperitoneal Lymphadenectomy, Radical Prostatectomy, and Hernioplasty

We present a case of prosthetic mesh hernia repair of a unilateral inguinal hernia following laparoscopic extraperitoneal pelvic lymph node dissection and radical prostatectomy. After an uneventful intraoperative and early postoperative period, the patient developed a lymphocele. This resulted in the detachment of the mesh from the abdominal wall, which necessitated its removal.

Fertility preserving surgery for carcinoma of the cervix

Cervical cancer remains the second most common female malignancy. Screening programmes have reduced the overall incidence, predominantly in the western world; however, this has led to a disproportionate rise in the incidence of early-stage disease, with a related increase in demand, for fertility-sparing techniques to be developed. Standard treatment for cervical cancer compromises fertility. A radical wide local excision of carefully selected early-stage tumours will allow conservation of the body of the uterus with a vaginoisthmic anastomosis enabling continuity of the vagina to be preserved following insertion of an isthmic cerclage suture. Pelvic node dissection may be performed at the same time by laparoscopic techniques. Over 900 cases have been performed and reported in the literature worldwide. Most have been carried out vaginally (radical vaginal trachelectomy and laparoscopic pelvic node dissection). A smaller number have been performed abdominally. There have been over 300 pregnancies reported with 196 live births. There has been a 10% significant prematurity rate with birth prior to 32 weeks. There have been 31 recurrences (4%), and 16 deaths (2%). Radical vaginal trachelectomy appears safe when performed in centres with appropriate experience of radical vaginal surgery and laparoscopic techniques. The impact of this new approach questions traditional teaching, thus preserving potential fertility in up until now impossible circumstances.

Laparoscopic Cystoprostatectomy in a Heart Transplant Recipient

A 72-year-old orthotopic cardiac transplant recipient with multiple, previously resected, cutaneous squamous cell carcinoma (SCC) presented with invasive SCC of the urinary bladder. At surgery, clot retention was managed with clot evacuation and continuous bladder irrigation to facilitate dissection. Laparoscopic cystoprostatectomy and bilateral pelvic lymph node dissection with extracorporeal ileal conduit urinary diversion were performed in 6 hours without complication. This approach minimized blood loss and allowed sufficient time out of steep Trendelenberg to reequilibrate the patient's cardiovascular system. Final pathology revealed SCC with perivesical fat invasion. This immunocompromised patient remains disease free 2 months after resection.

Conservative surgical management of small‐volume stage IB1 cervical cancer

To determine outcomes of women with small-volume stage IB1 disease managed by conservative surgical treatment. A retrospective review. The Northern Gynaecological Oncology Center, Queen Elizabeth Hospital, Gateshead, UK. Women with stage IB1 cervical cancer who were managed by conservative surgery over a 6-year period between 1 January 2000 and 31 December 2005. Pelvic lymph node metastases, recurrence rates and outcome survival. A total of 17 women with conservatively managed stage IB1 cervical cancer were identified. Their ages were 25-67 years, median 37 years, 4 women were nulliparous. All women presented with an abnormal screening smear showing at least severe dyskaryosis. Estimated tumour volumes ranged from 16 to 640 mm3, median 72 mm3. Four women showed multifocal invasion. All four nulliparous women and one parous woman underwent fertility-sparing treatment, i.e. loop cone +/- laparoscopic pelvic node dissection. The other 12 women underwent laparoscopic assisted vaginal hysterectomy/total abdominal hysterectomy +/- pelvic lymph node dissection. There were no cases of residual disease in any of the definitive treatment specimens. There were no cases of metastatic spread to pelvic lymph nodes. To date, no women have developed recurrent disease, and all women are alive and well (median follow up, 29 months). The conservative surgical management of small-volume stage IB1 cases in this series showed an excellent outcome with no cases showing pelvic lymph node involvement and no cases developing recurrent disease. A more formal assessment of tumour volume with a more active approach to determining the third dimension will allow more women the option of conservative treatment, thereby minimising the adverse effects of radical surgery.

1595: Laparoscopic Radical Prostatectomy and Bilateral Pelvic Lymph Node Dissection by Trans or Extraperitoneal Approach in Patients with Different Types of Previous Inguinal Hernia Repair

1595: Laparoscopic Radical Prostatectomy and Bilateral Pelvic Lymph Node Dissection by Trans or Extraperitoneal Approach in Patients with Different Types of Previous Inguinal Hernia Repair

Laparoscopic Seminal Vesicle and Pelvic Lymph Node Resection before High-Dose Three-Dimensional Conformal Radiation Therapy for Localized Prostate Cancer

Purpose: To analyze the dosimetric implications of seminal vesicle (SV) resection at the time of laparoscopic pelvic lymph node (PLN) dissection in patients presenting with high-risk prostate cancer regarding PLN and SV involvement. Patients and Methods: Between June and September 2005, twelve patients underwent laparoscopic SV resection and PLN dissection before delivering a total dose of 80 Gy through a three-dimensional conformal radiation therapy (3D-CRT). Dose-volume histograms (DVHs; rectum, bladder, femoral heads) were obtained from G1 (group 1 with SV) and G2 (group 2 without SV) according to either three- dimensional or intensity-modulated treatment planning. All DVH medians were compared using the nonparametric sign test. Results: SV resection during laparoscopic PLN dissection was performed in all twelve patients without major complications. DVH obtained with three-dimensional and intensity-modulated treatment planning showed that the median doses of RV 25% (25% of rectal volume), RV 50% , RFHV 5% (5% of right femoral head volume) and LFHV 5% (5% of left femoral head volume) in G1 were significantly higher compared to those obtained in G2. Conclusion: For patients presenting with high-risk prostate cancer, SV resection performed at the time of laparoscopic PLN dissection allows to significantly decrease the dose delivered to the rectum, using either three-dimensional or intensity-modulated treatment planning, and to reduce the risk of acute and late rectal toxicity.

Neoadjuvant chemotherapy followed by vaginal radical trachelectomy in bulky stage IB1 cervical cancer: Case report

Background. We present 3 young women with bulky stage IB1 cervical cancer treated with neoadjuvant chemotherapy followed by laparoscopic pelvic node dissection and vaginal radical trachelectomy. Cases. In the last year, we have treated 3 young women with large cervical lesions who wished to preserve fertility with induction chemotherapy followed by fertility-sparing surgery. They all had lesions measuring 3 to 4 cm and felt to be too big to safely undergo a radical trachelectomy. Three cycles of platinum-based combination chemotherapy were given and were well tolerated. The 3 patients had a significant clinical response to chemotherapy. A complete pathological response was confirmed by the absence of residual invasive cancer in the three trachelectomy specimens. There has been no recurrence so far and no pregnancy yet. Conclusion. Neoadjuvant chemotherapy followed by a fertility-sparing surgery may become a valuable option for young women with bulky stage IB1 cervical cancer who wish to preserve their fertility potential.

971what is the best surgical access? a comparison between transperitoneal and extraperitoneal laparoscopic extended pelvic lymph node dissection for patients at risk for lymph node metastases in clinically localized prostate cancer

971what is the best surgical access? a comparison between transperitoneal and extraperitoneal laparoscopic extended pelvic lymph node dissection for patients at risk for lymph node metastases in clinically localized prostate cancer