Page 24 - WJOLS - Journal of Laparoscopic Surgery

WJOLS

Port-site Metastasis after Minimally Invasive Surgery for Urological Malignancy
in the perioperative period because of factors like anes- • Use of an impermeable bag if morcellation is done 15
thetic agents, opioids, surgical trauma, blood transfu- • Use of a bag for intact specimen removal
sions, temperature changes, pain, and psychological • Placement of drain if needed before abdominal
23
stress. Some studies showed a better preservation of deflation 32
34
cell-mediated immunity after laparoscopic surgery. • Povidone-iodine irrigation of the laparoscopic instru-
29
However, these benefits are not applied to the peritoneal ments, trocar, and port-site wounds. Local applica-
level, possibly related to the hypoxic environment due to tion of cytotoxic agents, such as methotrexate and
pneumoperitoneum pressure and secondary effect of the cyclophosphamide, is also found to be effective 30
carbon dioxide in the peritoneal macrophage response. 34 • Suturing all port sites ≥10 mm 9,31
33
Factors related to laparoscopic surgical technique Burns et al demonstrated on an animal model that
26
contribute to port-site recurrence. These include the use port-site tumor implantation was significantly increased
of pneumoperitoneum, trocar site contamination, organ when only skin was closed compared with closure of all
and tumor morcellation, and the method of specimen three layers. The authors proved that closure technique
retrieval. The direct dissemination of tumor cells from may influence the rate of port-site tumor implantation.
contaminated material or from extraction with an open
bag has been reported. 5,6,23 Several studies have suggested CONCLUSION
that CO insufflation has an impact on the movement of Port-site metastasis in urological laparoscopic surgery is
2
tumor cells within the peritoneal cavity and subsequent rare and is preventable. Risk can be minimized by apply-
26
implantation at port sites. 12,27 Wittich et al found that ing open surgery oncological procedural principles. 31,34-62
aerosolization of tumor cells occurs during CO laparos-
2
28
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World Journal of Laparoscopic Surgery, September-December 2017;10(3):102-107 105