The traditional approach to patients with ovarian cancer is cytoreductive surg ery and surgical staging through a vertical midline laparotomy. While laparoscop y has become an integral part of gynecologic surgery, deb...The traditional approach to patients with ovarian cancer is cytoreductive surg ery and surgical staging through a vertical midline laparotomy. While laparoscop y has become an integral part of gynecologic surgery, debulking procedures have not been feasible to date with standard minimally invasive techniques. Twenty-f ive patients with ovarian carcinoma un-derwent surgical staging and cytoreducti on using hand-assisted laparoscopy. We review the surgical technique and clinic al outcomes. Twenty-five patients were managed during this study time frame wit h hand-assisted laparoscopy. Six patients had apparent advanced stage ovarian c ancer at the time of referral, and 17 patients had apparent early-stage ovarian cancer. Of the 19 patients with presumed early-stage disease, 5 patients were upstaged based on retroperitoneal lymph node involvement, 3 with disease to othe r pelvic structures, and 2 patients had microscopic disease in the omentum. Twen ty-two patients had their surgeries completed via hand-assisted laparoscopy, a nd three cases required conversion to laparotomy for completion of debulking sur gery. Complication rates were low with three complications requiring reoperation or hospitalization. The mean hospital stay was 1.8 days for the 22 patients who had a successful hand-assisted laparoscopic evaluation. Operating times were v ariable and ranged from 81 to 365 min. Hand-as-sisted laparoscopy may be emplo yed in the initial management of early and advanced stage ovarian carcinoma. Thi s approach allows for thorough evaluation of peritoneal and retroperitoneal stru ctures and surgical cytoreduction while retaining the advantages of minimally in vasive surgery.展开更多
文摘The traditional approach to patients with ovarian cancer is cytoreductive surg ery and surgical staging through a vertical midline laparotomy. While laparoscop y has become an integral part of gynecologic surgery, debulking procedures have not been feasible to date with standard minimally invasive techniques. Twenty-f ive patients with ovarian carcinoma un-derwent surgical staging and cytoreducti on using hand-assisted laparoscopy. We review the surgical technique and clinic al outcomes. Twenty-five patients were managed during this study time frame wit h hand-assisted laparoscopy. Six patients had apparent advanced stage ovarian c ancer at the time of referral, and 17 patients had apparent early-stage ovarian cancer. Of the 19 patients with presumed early-stage disease, 5 patients were upstaged based on retroperitoneal lymph node involvement, 3 with disease to othe r pelvic structures, and 2 patients had microscopic disease in the omentum. Twen ty-two patients had their surgeries completed via hand-assisted laparoscopy, a nd three cases required conversion to laparotomy for completion of debulking sur gery. Complication rates were low with three complications requiring reoperation or hospitalization. The mean hospital stay was 1.8 days for the 22 patients who had a successful hand-assisted laparoscopic evaluation. Operating times were v ariable and ranged from 81 to 365 min. Hand-as-sisted laparoscopy may be emplo yed in the initial management of early and advanced stage ovarian carcinoma. Thi s approach allows for thorough evaluation of peritoneal and retroperitoneal stru ctures and surgical cytoreduction while retaining the advantages of minimally in vasive surgery.
