Introduction: We report a novel technique for the vaginal placement of a single-incision laparoscopic device to aid in the removal of pelvic and para-aortic lymph nodes in patients undergoing gynecologic cancer surgery.

Technique Description: Informed consent for laparoendoscopic single-site total hysterectomy and bilateral salpingooophorectomy with pelvic and para-aortic lymph node dissection was obtained. A single-incision laparoscopic device was placed through a 2.5-cm umbilical incision, and a total laparoscopic hysterectomy with removal of the ovaries and tubes was performed. Preoperative pathologic analysis showed a grade 2 endometrioid adenocarcinoma of the endometrium, and as a result, bilateral pelvic and para-aortic lymph node dissection was completed. To aid in the lymphadenectomy, an additional transvaginal single-incision laparoscopic device was placed. The procedure was completed in 221 minutes, with 125 minutes spent on the pelvic and para-aortic lymph node dissection. There were no intraoperative or postoperative complications. The amount of blood loss was 50 mL. There were 10 pelvic lymph nodes and 5 para-aortic lymph nodes removed, with no carcinoma detected. The patient tolerated the procedure well and was discharged home the next day.

Discussion: Placement of a second transvaginal port is a feasible technique that provides great flexibility and assistance for lymph node removal in gynecologic cancer surgery.

Key Words: Endometrial cancer, Laparoscopic surgery, Lymph node dissection, Laparoendoscopic single-site surgery.

Download (PDF, Unknown)

The post Staging Endometrial Cancer first appeared on CRSLS.

Department of Urology, Toyama City Hospital, Toyama, Japan (all authors).

ABSTRACT

Introduction: Retroperitoneoscopic laparoendoscopic single-site surgery for congenital midureteral stricture was performed in a nulliparous girl with contralateral multicystic dysplastic kidney.

Case Description: The patient presented with a 4-year history of intermittent right flank pain and 3 episodes of right acute pyelonephritis. A right-sided retrograde ureteropyelogram showed a short and narrow stricture at the level of L5 with proximal hydroureteronephrosis. Ureterolysis and ureteroplasty were successfully performed via the retroperitoneal route. The total operation time was 200 minutes, and the estimated blood loss was 10 mL. The patient was discharged on postoperative day 5 with no complications. At the 12-month follow-up, the patient reported complete relief from pain and intravenous pyelography showed markedly decreased hydroureteronephrosis.

Discussion: Retroperitoneoscopic laparoendoscopic single-site surgery is an effective treatment option for congenital midureteral stricture with an acceptable esthetic outcome and minimal morbidity.

Key Words: Ureteral obstruction, Midureteral stricture, Laparoendoscopic single-site surgery, Retroperitoneoscopy, Multicystic dysplastic kidney disease.

Download (PDF, Unknown)

The post Laparoendoscopic Single-Site Surgery for Congenital Midureteral Stricture first appeared on CRSLS.