scholarly journals Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) for Low-grade Endometrial Cancer: The First Fifty Patients

2021 ◽  
Author(s):  
alexander burnett ◽  
Martha Rojo
Keyword(s):  
Endometrial Cancer ◽  
Endoscopic Surgery ◽  
Frozen Section ◽  
Patient Characteristics ◽  
Low Grade ◽  
Natural Orifice ◽  
Study Objective ◽  
University Population ◽  
Node Removal

Study Objective: To review our experience with low-grade endometrial cancer managed with vaginal natural orifice transluminal endoscopic surgery (vNOTES) to determine the feasibility of this approach. Design: Retrospective review of the first fifty cases of endometrial cancer treated by vNOTES Setting: Academic University Population: Fifty consecutive cases of vNOTES management of women with low-grade endometrial cancer were reviewed to detail patient characteristics, operative procedures and outcomes, complications and follow-up. Methods: Patients underwent vNOTES hysterectomy and bilateral salpingo-oophorectomy. If Mayo criteria for lymphadenectomy were met, a laparoscopic lymph node removal was performed. Main Results: Mean age was 63 (33-90); mean BMI was 35.4 (22-58). In 44 women, both tubes and ovaries were removed via vNOTES. Three women had their ovaries retained due to early age, one woman had exploration for removal of an ovary with metastatic disease, and two women had neither tubes nor ovaries removed due to atresia and inability to identify these organs. Two patients underwent laparoscopic lymphadenectomy on the bases of frozen section evaluation. Mean operative time was 98 minutes (30-215). Fourteen patients were discharged the day of surgery; 34 discharged after overnight observation; hospitalization was prolonged in one patient due to ileus and one patient underwent laparotomy 30 hours after vNOTES for bleeding. Conclusion: VNOTES is a feasible management strategy for women with low-grade endometrial cancer. It permits laparoscopic inspection of the abdomen and direct visualization of vascular pedicles. It can provide a rapid recovery with minimal discomfort and no visible scar.

vNotes (Vaginal Natural Office Transluminal Endoscopic Surgery)

2021 ◽  
pp. 321-336
Author(s):  
Jan Baekelandt
Keyword(s):  
Endometrial Cancer ◽  
Laparoscopic Surgery ◽  
Endoscopic Surgery ◽  
Paradigm Shift ◽  
Clinical Approach ◽  
Natural Orifice ◽  
Gynaecological Surgery ◽  
New Paradigm ◽  
Conventional Surgery ◽  
Almost All

vNOTES or vaginal Natural Orifice Transluminal Endoscopic surgery is a new paradigm shift in gynaecological surgery. A first paradigm shift from conventional surgery into laparoscopic surgery was firstly observed in the 1980s and 1990s. vNOTES may represent a shift from 90° to parallel surgery. Almost all benign gynaecological operations can be performed via vNOTES. The chapter presents the technique of vNOTES along with results of various benign and mainly malignant cases. In parallel, the clinical approach of endometrial cancer is widely discussed.

Solitary Cardiac Low-Grade Neuroendocrine Tumor: A Case Report and Review of the Literature

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S47-S47
Author(s):  
M Kavesh ◽  
P Drew ◽  
B Stewart
Keyword(s):  
Neuroendocrine Tumor ◽  
Frozen Section ◽  
Mitotic Rate ◽  
Complete Resection ◽  
Low Grade ◽  
Primary Tumors ◽  
Radiotracer Uptake ◽  
Pet Ct ◽  
The Right

Abstract Introduction/Objective Primary tumors of the heart are uncommon; even rarer are primary cardiac neuroendocrine tumors. To our knowledge, only two cases have been described to date, both being high-grade tumors. We report a solitary low-grade neuroendocrine tumor of the heart, unexpectedly discovered on the wall of the right ventricle in a 44-year-old man during aortic valve repair for infectious bacterial endocarditis. Results Frozen section was sent intraoperatively and showed a plasmacytoid neoplasm. Final pathology of the biopsies showed a tumor composed of both cohesive and discohesive plasmacytoid cells separated by a vascular network and strands of fibrosis. Neither necrosis nor a mitotic rate greater than 2 mitoses per 2 mm2 were seen. The tumor showed strong reactivity for AE1/3, synaptophysin and CDX2 with focal reactivity for chromogranin-A and CD56, confirming the diagnosis of a low-grade neuroendocrine tumor. Both an esophagogastroduodenoscopy and colonoscopy were performed and showed no evidence of a primary gastrointestinal tumor. PET-CT DOTATATE performed after complete resection of the tumor showed no abnormal radiotracer uptake. The possibility of an intestinal neuroendocrine tumor undetected by DOTATATE PET-CT with a single known metastasis to the heart was considered. This too, on the basis of the literature, was considered exceedingly rare. Complete resection of this patient’s tumor was considered sufficient treatment; the patient was advised to follow up annually with medical oncology. Conclusion The presentation and management of a solitary cardiac low-grade neuroendocrine tumor has not previously been described in the literature.

scholarly journals Natural orifice transvaginal endoscopic surgery for endometrial cancer

2014 ◽  
Vol 3 (3) ◽  
pp. 89-92 ◽  
Author(s):  
Chyi-Long Lee ◽  
Kai-Yun Wu ◽  
Fang-Ying Tsao ◽  
Chen-Ying Huang ◽  
Chien-Min Han ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Endoscopic Surgery ◽  
Natural Orifice

scholarly journals Repeat Vaginal Natural Orifice Transluminal Endoscopic Surgery: A First Feasibility Study

2021 ◽  
pp. 1-6
Author(s):  
Katrien Nulens ◽  
Ilse Van Genechten ◽  
Jan Baekelandt
Keyword(s):  
Peritoneal Cavity ◽  
Endoscopic Surgery ◽  
Large Scale ◽  
Case Series ◽  
Small Sample ◽  
Invasive Technique ◽  
Natural Orifice ◽  
Adnexal Surgery

<b><i>Objectives:</i></b> Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging minimally invasive technique in benign gynaecologic surgery whereby surgical access to the peritoneal cavity is achieved through natural orifices, namely through a vaginal colpotomy. Experience in repeat vNOTES cases is limited and so far, repeat vNOTES cases have not been described in the literature. The purpose of this study was to demonstrate the feasibility of vNOTES hysterectomy in women with a history of previous vNOTES adnexal surgery. <b><i>Design:</i></b> We performed a retrospective cohort study of the first 11 repeat vNOTES cases in our centre. All vNOTES procedures, primary adnexal surgery as well as repeat vNOTES hysterectomy, were performed by one surgeon (J.B.). <b><i>Materials, Setting, Methods:</i></b> Between March 2016 and May 2020, 11 patients underwent a vNOTES hysterectomy after prior vNOTES adnexectomy or cystectomy in Imelda Hospital, Bonheiden, Belgium. Relevant patient characteristics and outcome data were collected after written informed consent. <b><i>Results:</i></b> Median age was 49 years (range 44–65) at the moment of the first vNOTES procedure. Two patients had one or more caesarean sections in history, and 2 women were nulliparous. Median interval between primary and repeat vNOTES procedure was 15 months (range 0.8–37 months). All patients underwent a vaginally assisted NOTES hysterectomy (VANH) as repeat vNOTES procedure. Performing a colpotomy and entering the peritoneal cavity after prior vNOTES was technically feasible in all cases. All VANHs were successfully performed. There were 3 minor complications after repeat vNOTES, of which one was anaesthesia-related. The 2 complications associated with the surgical procedure were both cystitis. In one of these 2 patients, there were high post-void residues, which were easily managed by bladder training. There were no conversions to laparoscopy or laparotomy, neither serious nor life-threatening complications. No ureteric, bladder, or intestinal injuries have occurred. <b><i>Limitations:</i></b> The retrospective design and small sample size are the main limitations of this study. Moreover, the follow-up period of the most recently operated patients was too short to draw conclusions on long-term outcomes, including sexual function. <b><i>Conclusions:</i></b> In all patients in this case series, vNOTES hysterectomy after prior vNOTES adnexal surgery was successfully performed. Large-scale prospective trials with long-term follow-up are needed to evaluate the safety and feasibility of multiple consecutive vNOTES procedures in 1 patient.

Pure Natural Orifice Translumenal Endoscopic Surgery Management of Simple Renal Cysts: 2-Year Follow-Up Results

2011 ◽  
Vol 25 (1) ◽  
pp. 75-80 ◽  
Author(s):  
En-Chun Li ◽  
Jian-Quan Hou ◽  
Lin-Bin Yang ◽  
He-Xing Yuan ◽  
Li-Hua Hang ◽  
...  
Keyword(s):  
Endoscopic Surgery ◽  
Renal Cysts ◽  
Natural Orifice ◽  
Surgery Management

scholarly journals Clinical patterns and genomic profiling of recurrent ‘ultra-low risk’ endometrial cancer

2020 ◽  
Vol 30 (6) ◽  
pp. 717-723 ◽  
Author(s):  
Marina Stasenko ◽  
Noah Feit ◽  
Simon S K Lee ◽  
Cassandra Shepherd ◽  
Robert A Soslow ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Massively Parallel Sequencing ◽  
Tumor Grade ◽  
Low Risk ◽  
Small Subset ◽  
Low Grade ◽  
Primary Tumors ◽  
Gynecology And Obstetrics ◽  
Endometrial Cancers

ObjectiveDespite good prognosis for patients with low-risk endometrial cancer, a small subset of women with low-grade/low-stage endometrial cancer experience disease recurrence and death. The aim of this study was to characterize clinical features and mutational profiles of recurrent, low-grade, non-myoinvasive, ‘ultra-low risk’ endometrioid endometrial adenocarcinomas.MethodsWe retrospectively identified patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA endometrioid endometrial cancers who underwent primary surgery at our institution, between January 2009 and February 2017, with follow-up of ≥12 months. ‘Ultra-low risk’ was defined as FIGO tumor grade 1, non-myoinvasive, and lacking lymphovascular space invasion. Tumor-normal profiling using massively parallel sequencing targeting 468 genes was performed. Microsatellite instability was assessed using MSIsensor. DNA mismatch repair (MMR) protein proficiency was determined by immunohistochemistry.ResultsA total of 486 patients with ultra-low risk endometrioid endometrial cancers were identified: 14 (2.9%) of 486 patients developed a recurrence. Median follow-up for non-recurrent endometrioid endometrial cancers: 34 (range 12–116) months; for recurrent endometrioid endometrial cancers: 50.5 (range 20–116) months. Patients with recurrent disease were older, had lower body mass index, and were most commonly non-White (p=0.025, p<0.001, and p<0.001, respectively). Other clinical characteristics did not differ. MMR immunohistochemistry was obtained for 211 (43%) tumors: 158 (75%) MMR-proficient and 53 (25%) MMR-deficient. Primary tumors of 9 recurrent and 27 non-recurrent endometrioid endometrial cancers underwent mutational profiling. Most were microsatellite stable (6/9, 67% recurrent; 25/27, 93% non-recurrent). Recurrent PTEN and PIK3CA mutations were present in both groups. Exon 3 CTNNB1 hotspot mutations were found in 4/9 (44%) recurrent and 8/27 (30%) non-recurrent (p=0.44).ConclusionsPatients diagnosed with ultra-low risk endometrioid endometrial cancers have an overall excellent prognosis. However, in our study, 2.9% of patients with no identifiable clinical or pathologic risk factors developed recurrence. Further work is warranted to elucidate the mechanism for recurrence in this population.

Sign in / Sign up

Export Citation Format

Share Document