Page 11 - WALS Journal

WJOLS

Laparoendoscopic Single-Site Surgery in Gynecologic Oncology

particularly for early-stage endometrial cancer where the However, the surgeons can nowadays perform easily
tumor is limited to the uterus, become easy and feasible, hysterectomy easily with bilateral salpingo-oophorectomy
also the patient will stay for short period in the hospital, so to treat the endometrial cancer laparoscopically by LESS
there is clear improvement in quality of life. 34 surgery via a single-site incision. This will be done by
The surgical staging of endometrial cancer is very utilizing the newest generation of port systems that allow
important because it gives picture about the method of the several laparoscopic instruments to be used in the same time
treatment and prognosis, but an alternative method of through a single-operating trocar.
surgically staging is a LESS approach. In general, this Absolute contraindications to the performance of LESS
approach is limited to a selected group of women with include cancer patients with evidence of metastatic disease,
stage I disease. However, laparoscopic pelvic and para- also patients with poor pulmonary function who cannot stay
aortic lymph node dissection may also be done in women in the positioning required for LESS, but relative
who are incompletely staged at their primary surgery. 35 contraindications are dependent on surgeon experience and
There is another minimally invasive alternative method skillful level in LESS. Trials of the operations done by LESS
for laparoscopy which is called robotic surgery, which is in gynecology are given in the Table 1.
used nowadays in surgical treatment of endometrial cancer,
the use of robotic procedures for treating gynecologic DISCUSSION
oncology diseases has increased alot nowadays as many The treatment of gynecological oncology diseases has been
36
studies have proved that. This robotic surgery has great developed nowadays. The old concept for treatment of
benefits, like improvement of surgeon movement, and gynecological tumors is radical surgery by laparotomy to
allows 3-D optics. Recent reports demonstrate that give a good field to manipulate the tumor as in endometrial
endometrial cancer staging can be performed with a daVinci cancer or ovarian cancer but nowadays this method has been
surgical system which is preferable over abdominal staging changed as minimally invasive surgery for patients with
and also over the laparoscopic staging because it gives many gynecologic malignancies has progressively increase.
advantages, like enhancement of lymph nod excision, Numerous studies have proved that laparoscopic
decrease in the blood loss and decrease in operative time. 37 approaches to various gynecologic oncology conditions

Table 1: Summary of trials of the operations done by LESS in gynecology
References Type of No. of Type of Duration Blood Hospital Complications Conversion
(years) study patient operation of the loss stay rate (%) to other
surgery (CC) (day) method (%)
(min)
Ghezzi, Cromi Prospective 10 SPL 27 - 1 0 0
et al (2005) salpingectomy
Kim, Lee Prospective 24 SPA-LAVH 199 400 3 - 3
et al (2008)
Lim, Kim - 12 Adnexectomy 73 10 1 0 0
et al (2009)
Fader and - 13 Adnexectomy 65 - 1 0 0
Escobar (2009)
Kim, Lee Prospective 24 Salpingo- 70 10 1 0 12
et al (2009) oophorectomy
Yoon, Park Prospective 20 SPL 55 Minimal 2 2
et al (2009) salpingectomy
Yoon, Kim Prospective 7 Hysterectomy 157 200 4 0 0
et al (2009)
Langebrekke and - 1 Total laparoscopic 60 Minimal 5 hrs 0 0
Qvigstad (2009) hysterectomy with
single-port access
without vaginal
surgery
Fader and Retrospective 30 Endometrial ovarian 65 Minimal 1 0 0
Escobar (2009) cancer staging
hysterectomy/
bilateral salpingo-
oophorectomy
Escobar, Bedaiwy Cohort 7 LESS surgery for - 75 >24 hrs 0 14
et al (2010) benign adnexal disease

World Journal of Laparoscopic Surgery, September-December 2012;5(3):121-127 125