Objective.:To retrospectively evaluate the feasibility and morbidity of total laparoscopic radical hysterectomy and lymphadenectomy. Methods.:We performed a retrospective review of all patients who underwent a total l...Objective.:To retrospectively evaluate the feasibility and morbidity of total laparoscopic radical hysterectomy and lymphadenectomy. Methods.:We performed a retrospective review of all patients who underwent a total laparoscopic radical hysterectomy at our institution between May 2004 and August 2005. Data collected included age,body mass index,stage,histopathologic subtype,tumor grade,estimated blood loss,perioperative blood transfusions,number and status of lymph nodes obtained,status of surgical margins,length of hospital stay,time to resumption of normal bladder function,intraoperative and postoperative complications,and disease-free interval. Results.:Twenty patients underwent total laparoscopic radical hysterectomy during the study period. None of the surgeries required conversion to laparotomy. The median patient age was 41.5 years (range,25-76). Eighteen patients had cervix cancer (5 stage IA2 and 13 stage IB1),and 2 had endometrial cancer (1 stage IB and 1 stage IIIA). Among those with cervix cancer,12 had adenocarcinoma,4 squamous cell carcinoma,and 2 adenosquamous carcinoma. The median weight was 70 kg (range,49-112). The median number of resected pelvic lymph nodes was 13 (range,9-26). One patient had nodal disease. The surgical margins were free of disease in all cases. The median blood loss was 200 ml (range,25-700 ml). Only 1 patient required an intraoperative blood transfusion (1 U packed red blood cells). The median length of hospital stay was 1 day (range,1-5). There were 3 short-term complications-unintentional cystotomy,pulmonary embolus,and pneumomediastinum with subcutaneous emphysema. There were 2 long-term complications-vaginal eviscerations and a lymphocyst. The median time to resumption of normal bladder function was 16 days (range,13-29). The median follow-up time was 8 months range (1-16). All patients remain free of disease at the time of this report. Conclusions.:Total laparoscopic radical hysterectomy can be performed safely with minimal blood loss and postoperative morbidity,and patients undergoing this proceduremay be discharged after an overnight stay in the hospital.展开更多
Objective: To describe an IVF surrogate pregnancy from a patient who had a radical hysterectomy followed by excision of a laparoscopic port site implantation with ovarian transposition followed by abdominal wall irrad...Objective: To describe an IVF surrogate pregnancy from a patient who had a radical hysterectomy followed by excision of a laparoscopic port site implantation with ovarian transposition followed by abdominal wall irradiation and chemotherapy, which resulted in premature ovarian failure from which there was partial recovery. Design: Case report. Setting: Tertiary referral university women’s hospital in Sydney, Australia and private reproductive medicine clinic in California. Patient(s): A 34- year- old woman who underwent laparoscopy for pelvic pain, shortly afterward followed by radical hysterectomy and pelvic lymph node dissection, who subsequently developed a laparoscopic port site recurrence, which was excised in association with ovarian transposition before abdominal wall irradiation and chemotherapy. Intervention(s): Modified IVF treatment, transabdominal oocyte retrieval, embryo cryopreservation in Australia, and transfer to a surrogate mother in the United States. Main Outcome Measure(s): Pregnancy. Result(s): Miscarriage in the second cycle and a twin pregnancy in the fourth cycle. Conclusion(s): This is the first case report of ovarian stimulation and oocyte retrieval performed on transposed ovaries after a patient developed premature ovarian failure after radiotherapy and chemotherapy with subsequent partial ovarian recovery.展开更多
文摘Objective.:To retrospectively evaluate the feasibility and morbidity of total laparoscopic radical hysterectomy and lymphadenectomy. Methods.:We performed a retrospective review of all patients who underwent a total laparoscopic radical hysterectomy at our institution between May 2004 and August 2005. Data collected included age,body mass index,stage,histopathologic subtype,tumor grade,estimated blood loss,perioperative blood transfusions,number and status of lymph nodes obtained,status of surgical margins,length of hospital stay,time to resumption of normal bladder function,intraoperative and postoperative complications,and disease-free interval. Results.:Twenty patients underwent total laparoscopic radical hysterectomy during the study period. None of the surgeries required conversion to laparotomy. The median patient age was 41.5 years (range,25-76). Eighteen patients had cervix cancer (5 stage IA2 and 13 stage IB1),and 2 had endometrial cancer (1 stage IB and 1 stage IIIA). Among those with cervix cancer,12 had adenocarcinoma,4 squamous cell carcinoma,and 2 adenosquamous carcinoma. The median weight was 70 kg (range,49-112). The median number of resected pelvic lymph nodes was 13 (range,9-26). One patient had nodal disease. The surgical margins were free of disease in all cases. The median blood loss was 200 ml (range,25-700 ml). Only 1 patient required an intraoperative blood transfusion (1 U packed red blood cells). The median length of hospital stay was 1 day (range,1-5). There were 3 short-term complications-unintentional cystotomy,pulmonary embolus,and pneumomediastinum with subcutaneous emphysema. There were 2 long-term complications-vaginal eviscerations and a lymphocyst. The median time to resumption of normal bladder function was 16 days (range,13-29). The median follow-up time was 8 months range (1-16). All patients remain free of disease at the time of this report. Conclusions.:Total laparoscopic radical hysterectomy can be performed safely with minimal blood loss and postoperative morbidity,and patients undergoing this proceduremay be discharged after an overnight stay in the hospital.
文摘Objective: To describe an IVF surrogate pregnancy from a patient who had a radical hysterectomy followed by excision of a laparoscopic port site implantation with ovarian transposition followed by abdominal wall irradiation and chemotherapy, which resulted in premature ovarian failure from which there was partial recovery. Design: Case report. Setting: Tertiary referral university women’s hospital in Sydney, Australia and private reproductive medicine clinic in California. Patient(s): A 34- year- old woman who underwent laparoscopy for pelvic pain, shortly afterward followed by radical hysterectomy and pelvic lymph node dissection, who subsequently developed a laparoscopic port site recurrence, which was excised in association with ovarian transposition before abdominal wall irradiation and chemotherapy. Intervention(s): Modified IVF treatment, transabdominal oocyte retrieval, embryo cryopreservation in Australia, and transfer to a surrogate mother in the United States. Main Outcome Measure(s): Pregnancy. Result(s): Miscarriage in the second cycle and a twin pregnancy in the fourth cycle. Conclusion(s): This is the first case report of ovarian stimulation and oocyte retrieval performed on transposed ovaries after a patient developed premature ovarian failure after radiotherapy and chemotherapy with subsequent partial ovarian recovery.
