Radical Vaginal Trachelectomy

Recently, radical vaginal hysterectomy (RVH) has developed into laparoscopically assisted radical vaginal hysterectomy (LARVH), which is associated with the laparoscopical procedure, and it is applied as radical vaginal trachelectomy and semi-radical vaginal hysterectomy. LARVH is indicated for patients with stage IB1 and IIA1 cervical carcinoma, especially those with a tumor size of less than 2 cm, because the cardinal ligaments cannot be resected widely. Although RVH that is associated with laparoscopic pelvic lymphadenectomy is the most used surgical procedure, radical trachelectomy may be performed either abdominally or vaginally (laparoscopic or robotic). One report found that the pregnancy rate was higher in patients who underwent minimally invasive or radical vaginal trachelectomy than in those who underwent radical abdominal trachelectomy.

Laparoscopic or Minimally Invasive Surgery in the Treatment of Cervical Cancer

Cervical cancer is the most common cause of death in female patients over 45 years of age. Surgical treatment (laparoscopic total hysterectomy and radical hysterectomy plus laparoscopic pelvic lymphadenectomy) is the most curative therapeutic resource in the initial stages (Ia1, Ia2 and Ib1). The treatment adopted in the development of this pathology is fundamental as the technique used to determine the prognosis of cervical cancer and obtain information on lymphatic involvement. Imaging techniques have advanced in recent years, but the only reliable way to detect lymph node involvement is the pathological study of the extracted pieces. The goal of laparoscopic staging is to assess bladder, bowel, and lymph node involvement and intra-abdominal disease. Laparoscopic pelvic and lumboaortic lymphadenectomy is effective in staging and treating gynecologic cancers. Laparoscopic lumboaortic lymphadenectomy has few complications, rescues an acceptable number of lymph nodes, and requires a shorter hospital stay. In addition, it identifies cervical cancers that require extended-field radiation therapy.

Sepsis Due to Port-Site Abscess in Laparoscopic Pelvic Lymphadenectomy: A Case Report

Port-site infection is one of the most frequent complications in gynaecological laparoscopy. We present a rare case of port-site infection complicated by an abdominal wall abscess and sepsis. We conduct a literature review and discuss the difficulties of diagnosis and the management of this clinical situation.

A retrospective study of internal small bowel herniation following pelvic lymphadenectomy for gynecologic carcinomas

After pelvic lymphadenectomy (PLA), pelvic vessels, nerve, and ureter are skeletonized. Internal hernias beneath the skeletonized pelvic structure following pelvic lymphadenectomy (IBSPP) are a rare complication following PLA. To the best of our knowledge, only 12 IBSPP cases have been reported and clinical details on such hernias remain unknown. The aim of the study was to investigate the incident and etiology of IBSPP. 1313 patients who underwent open or laparoscopic pelvic lymphadenectomy were identified from our database. A retrospective review was performed. Mean follow-up period was 33.9 months. A total of 12 patients had IBSPP. Multivariate analysis of laparoscopic surgeries group as compared to open surgeries group, para-aortic lymphadenectomy rate, number of dissected lymph nodes by PLA, antiadhesive material use rate, and blood loss were lower in laparoscopic surgeries group: odd ratio (OR) = 0.13 [95% confidence interval (CI) 0.08–0.19], and OR = 0.70 [95% CI 0.50–0.99], OR = 0.17 [95% CI 0.10–0.28], OR = 0.93 [95% CI 0.92–0.94]. However, no significant difference was observed in the incidence of IBSPP between laparoscopic surgery (1.0%) and open surgery (0.8%). All IBSPP occurred in the right pelvic space. These findings may contribute to the development of prevention methods for this disease.

Internal hernia beneath superior vesical artery after pelvic lymphadenectomy for cervical cancer: a case report and literature review

Background The common complications of radical hysterectomy and pelvic lymphadenectomy usually include wound infection, hemorrhage or hematomas, lymphocele, uretheral injury, ileus and incisional hernias. However, internal hernia secondary to the orifice associated with the uncovered vessels after pelvic lymphadenectomy is very rare. Case presentation We report a case of internal hernia with intestinal perforation beneath the superior vesical artery that occurred one month after laparoscopic pelvic lymphadenectomy for cervical cancer. A partial ileum resection was performed and the right superior vesical artery was transected to prevent recurrence of the internal hernia. Conclusions Retroperitonealization after the pelvic lymphadenectomy should be considered in patients with tortuous, elongated arteries which could be causal lesions of an internal hernia.

External Iliac Artery Injury and Thrombosis during Laparoscopic Gynecologic Surgery

Although vascular injury during laparoscopic surgery is rare, it is occasionally reported. Previously, several physicians have reported cases of compartment syndrome resulting from a thrombus during gynecologic surgery. However, few reports describe thrombosis occurring in artery vessels as a result of applying angiopressure. Herein, we report the case of a 53-year-old woman with endometrioid carcinoma and a vascular injury that resulted in thrombus formation; this is the first such case to be reported. The complication was successfully treated by means of direct anastomosis following partial resection of the injured iliac artery. This is the first report of a case in which applying angiopressure for a vascular injury during laparoscopic pelvic lymphadenectomy led to an intra-arterial thrombus which was found and treated without sequelae.