Department of Urology, Naval Medical Center San Diego, San Diego, CA, USA (Drs Santomauro, Stroup, Masterson, Auge, Crain, J. L’Esperance, and Ms A. L’Esperance). Division of Urology, University of California, San Diego, CA, USA (Drs Stroup and Derweesh).

ABSTRACT

Background and Objectives: Robotic-assisted laparoscopic retroperitoneal lymph node dissection (RPLND) using a lower abdominal approach for testicular cancer is an advanced and relatively new surgical technique. Herein we describe technical modifications, review benefits, and report our initial series.

Methods: A retrospective review of 16 patients from Jan 1, 2010 to Dec 31, 2012 who underwent robotic RPLND for nonseminomatous germ cell tumors was performed. Patients were positioned in 15° of Trendelenburg and tilted 15° to the right. An infraumbilical midline camera port, 3 robotic ports, and 2 assistant ports were placed in a lower abdominal configuration. Patient demographic and perioperative outcomes were assessed.

Results: Twelve patients underwent staging, prospective nerve-sparing RPLNDs, and 4 underwent postchemotherapy RPLNDs. Mean age was 26.4 years with a mean body mass index of 27.4 kg/m2. The cohort had a mean operative time of 357 minutes, mean estimated blood loss of 205 mL, mean hospital stay of 3.6 days, and mean postoperative morphine equivalent use of 47.1 mg. There were no conversions to open RPLND in this cohort. An average of 26.2 lymph nodes were sampled.

Conclusions: Inferior approach for robotic RPLND enables a thorough dissection of the retroperitoneum, without repositioning, to meet oncologic goals. Further study to evaluate long-term outcomes is warranted.

Key Words: Retroperitoneal lymph node dissection, Robotic surgery, Surgical approaches, Technical modifications, Testicular cancer.

The post Supine Robotic-Assisted Retroperitoneal Lymph Node Dissection for Testicular Cancer first appeared on CRSLS.

Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA (all authors).

ABSTRACT

Instances of iatrogenic endometriosis after laparoscopic supracervical hysterectomy are uncommon but have been reported in the literature in women undergoing hysterectomy for pelvic pain. A 41-year-old woman with no history of endometriosis developed cyclic pain and a mass in her lower abdominal wall after uterine morcellation for a laparoscopic supracervical hysterectomy and sacrocolpopexy for uterocervical prolapse. Exploratory surgery revealed an endometrial implant involving the peritoneum and omentum, with transmural involvement of the cecum at a site separate from the trocar site. Aberrant endometrial cell implantation after morcellation of the uterine corpus has been reported; however, this was a rare instance of transmural large bowel iatrogenic endometriosis, necessitating a partial bowel resection, in a patient without a history of endometriosis or pelvic pain, at a site remote from where the uterus was morcellated and removed. In light of recent concerns over dissemination of occult cancerous cells, this case illustrates that dissemination of noncancerous cells can similarly have detrimental outcomes for patients.

Key Words: Endometriosis, Laparoscopy, Supracervical hysterectomy, Uterine morcellation.

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The post De Novo Endometrial Implant Into the Colon After Uterine Morcellation first appeared on CRSLS.