Robot-assisted laparoscopic radical trachelectomy using three robotic arms

Radical trachelectomy is an alternative method to preserve the fertility of young women with early stage cervical cancer. Abdominal radical trachelectomy has been replaced with laparoscopic radical trachelectomy in selected patients due to several advantages of laparoscopic surgery compared to laparotomy. Recently, as surgical technology has significantly advanced, robotassisted procedures have been performed. However, there are only four case reports of robot‐assisted radical trachelectomy where four robotic arms were used. This report may be the first to describe robot‐assisted laparoscopic radical trachelectomy which uses only 2 robotic instruments ports and 1 assistant port while preserving the ascending branches of both uterine arteriesope

Two-port access laparoscopic radical hysterectomy: First clinical report

Recently, laparoscopic radical hysterectomy has been established as a feasible alternative to an open radical procedure. Current trials are aimed at further reducing the postoperative morbidity so new schemes of laparoscopic surgery, such as embryonic natural orifice transumbilical endoscopic surgery are being developed. We introduce our two-port access laparoscopic radical hysterectomy technique using a single multi-channel port and 5-mm ancillary port. Our two-port technique seems to be minimally invasive with a decrease in morbidity and offers cosmetic benefits with less visible scars. Two-port access laparoscopic radical hysterectomy with a pelvic and paraaortic lymph node dissection in selected gynecologic cancer patients may be feasible for experienced laparoscopic surgeonsope

Single-Port Laparoscopic Surgery in Extensive Peritoneal and Ovarian Endometriosis

Objective: The aim of this study was to assess the feasibility and safety of Single-Port Access (SPA) Laparoscopic Complete Excision (LCE) in severe endometriosis of the adnexa and pelvic peritoneum. Methods: The surgical outcomes of 40 consecutive patients that underwent SPA-LCE were compared with those from the control group with conventional LCE. Results: The mean operating time was 102 min for the SPA group and 103.4 min for the conventional group, respectively (P=0.899). Both groups had the same estimated blood loss (50 mL). The mean postoperative hospital stay of the SPA group was 1.9 days and shorter than that for the conventional group (2.8 days, P=0.008). The mean postoperative pain score after 48-hours of the SPA group was lower as compared to that of the conventional group (1.9 vs. 2.8, P=0.001). There was no operative complication in either group. Conclusion: SPA-LCE was feasible as a minimal invasive surgery for the treatment of severe endometriosis of the adnexa and pelvic peritoneum.ope

A rare case of primary adenosquamous carcinoma arising from ovary

Primary adenosquamous carcinoma of ovary is extremely rare malignancy. We report a case of primary adenosquamous carcinoma of the ovary which has not been reported in Korea before. The case of a 32 year old woman, evaluated for palpable abdominal mass is presented. Ultrasonography, abdomino-pelvic MRI, PET-CT were suggestive of a malignant neoplastic process. Surgical debulking operation including total abdominal hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic lymph node dissection, para-aortic lymph node biopsy, total omentectomy, incidental appendectomy and low anterior resection of rectum were performed. Histopathology demonstrated primary adenosquamous carcinoma arising from the left ovary to the myometrium, serosa, rectal wall mass and omentum. The staging for ovarian tumor was consistent with FIGO stage IV. We present a case of this rare malignancy.ope

Transumbilical single port total Laparoscopic hysterectomy

Laparoscopic hysterectomy is currently considered the standard procedure in many patients who need hysterectomy. To reduce incisional morbidity and improve cosmetic outcomes we performed transumbilical single-port total laparoscopic hysterectomy using a special "single three-channel port" and standard laparoscopic tools with virtually no scar. We used an Alexis wound retractor (Applied Medical, CA, USA) and a surgical glove as the "single three-channel port". In this paper, we report four cases of total laparoscopic hysterectomy performed exclusively through an umbilical incision using a single three-channel port.ope

긴 비암호화 리보핵산 SRA가 Notch pathway를 통해 자궁경부암의 침투 및 진행에 미치는 역할 규명

Background: Recent research has focused on the impact of long noncoding RNA (lncRNA) in cervical carcinogenesis. However, whether steroid receptor activator (SRA) lncRNA is involved in cervical cancer remains to be elucidated. Materials and Methods: We investigated the bio-functional consequences of SRA knockdown in vitro. To determine the role of SRA in cell proliferation, migration, and invasion, RNA interference was used to knockdown SRA expression in cervical cancer cells. Results: We found SRA knockdown inhibited cell proliferation, migration, and tumor invasion. In vitro experiments using the SRA-knockdown CaSki and SiHa cell line revealed that SRA was a strong inducer of tumor growth and a modulator of the expression of epithelial mesenchymal transition and Notch signaling pathway-related genes. Conclusion: Our results suggested that SRA is associated with invasiveness and biological aggressiveness in cervical cancer cells. Thus, SRA may be a potential therapeutic target and biological marker for cervical cancer.open박

Overcoming technical difficulties with single-port access laparoscopic surgery in gynecology: using conventional laparoscopic instruments.

AIM: The aim of this report was to investigate ways to overcome technical difficulties of the single-port access (SPA) laparoscopic surgery using conventional laparoscopic instruments in gynecology. METHODS: We performed 140 cases of SPA total laparoscopic hysterectomy for benign gynecologic diseases and 40 cases of two-port access laparoscopic surgery for gynecologic cancers. The conventional laparoscopic instruments, including a 45-cm-long, 5-mm-diameter, 30-degree-angled laparoscope, a 90-degree light cable adaptor, a curved instrument, and nonbulky trocars, and intracorporeal suturing and tying technique were used. RESULTS: All operations were laparoscopically completed with no conversion to conventional laparoscopy or laparotomy. We obtained tolerable surgical outcomes with these instruments. CONCLUSIONS: As the technical difficulties have been overcome, the SPA laparoscopic surgery will be a more and more widespread procedure in the gynecologic field with only minimal skin incision.ope

Two-port access versus conventional staging laparoscopy for endometrial cancer.

OBJECTIVE: The purpose of this study was to compare surgical outcomes of 2-port access (TPA) and conventional laparoscopy in staging operations for endometrial cancer. The ultimate goal of TPA system was to perform proper cancer operation with less invasive access and to complement technical limitations of minimally invasive surgery. METHODS: The TPA system consisted of a single multi-channel port system at the umbilicus and an ancillary 5-mm trocar in the suprapubic area. Twenty-one consecutive patients who underwent TPA staging laparoscopy for endometrial cancers were enrolled in the study. Data coming from this group of patients were prospectively collected and compared with those coming from 42 consecutive patients who underwent conventional staging laparoscopy for the same period. The selected patients were matched (1:2 ratio) to control patients based on age (± 5 years), body mass index, and tumor stage. RESULTS: Patient status was estimated in operative morbidity and surgical outcomes. All operations were completed laparoscopically, with no conversion to laparotomy. The TPA group had a significantly longer operating time (238 ± 51 minutes vs 188 ± 65 minutes; P = 0.001), more retrieved para-aortic lymph nodes (13 vs 5; P < 0.001), shorter postoperative hospital stay (5 vs 8 days; P = 0.001), and less postoperative pain (P = 0.045). There were no postoperative complications requiring further management. CONCLUSIONS: Two-port access staging laparoscopy using a single multi-channel port system could be a feasible procedure in selected patients with endometrial cancer with only minimal skin incisions. Prospective randomized trials will permit the evaluation of potential benefits of this minimally invasive surgical technique.ope

Clinical impact of high mobility group box 1 protein in epithelial ovarian cancer

PURPOSE: The aim of this study was to confirm the expression of high mobility group box 1 (HMGB1) in patients with epithelial ovarian cancer (EOC) and to evaluate the prognostic significance of HMGB1. METHODS: A total of 74 patients with EOC comprised our cohort. Retrospectively collected tissue microarray from EOC patients treated with debulking surgery followed by taxane and platinum chemotherapy were analyzed for evaluation of the prognostic significance of HMGB1. Expression of HMGB1 was assessed by immunohistochemistry. RESULTS: The positive staining was detected in 80% of EOC patients and the rate of high HMGB1 expression was 42%. In advanced stage, patients with high HMGB1 expression showed a poorer prognosis than low HMGB1 expression group [median progression-free survival (PFS), 10.8 vs. 21.7 months, P = 0.005]. High HMGB1 expression was an independent predictor for PFS (P = 0.024). CONCLUSIONS: HMGB1 expression is expected as a promising biomarker for EOC and further studies are needed to assess potential roles in EOC.restrictio

Learning curve and surgical outcome for single-port access total laparoscopic hysterectomy in 100 consecutive cases.

AIMS: To define the learning curve for single-port access (SPA) total laparoscopic hysterectomy (TLH) and evaluate the surgical outcomes. METHODS: Patient demographics and segmental operating times of all 100 patients who underwent SPA-TLH by a single surgeon were analyzed. Patients were arranged in order based on surgery date. RESULTS: 100 patients underwent SPA-TLH. There was no conversion to conventional laparoscopy or laparotomy. The median time until the removal of a specimen (T(R)) was 45 min and the median time for closure of the vaginal cuff (T(C)) was 18 min. The median total operating time from skin opening to closure (T(O)) was 80 min. T(R), T(C), and T(O) decreased significantly over the study period. The T(C) decreased significantly from the first 20 cases to the next 20 (p = 0.028) and the T(O) from the second 20 cases to the next 20 (p = 0.029). CONCLUSIONS: Proficiency for SPA-TLH was achieved after 40 cases. Operating time and postoperative hemoglobin drop decreased with experience, without increasing complication.ope