Robotic approach using simple and radical hysterectomy for endometrial cancer with long-term follow-up evaluation.

BACKGROUND: Feasibility and outcome of robotic-assisted laparoscopy (RAL) for endometrial cancer was evaluated with a mean follow-up of 4 years. METHODS: Robotic hysterectomy (RH) and type B robotic radical hysterectomy (RRH), with or without pelvic lymphadenectomy (PLH), was performed on 51 consecutive patients. Records were reviewed for demographic data, medical/surgical history and comorbidities, perioperative findings and outcomes, as well as long-term complications and recurrences. Regarding stage, according to 2009 FIGO, 25% of cases were IA, while 20%, 53% and 2% of cases were, respectively, IB, II and IIIA stage. RESULTS: Twenty-eight patients underwent RRH + PLH (54.9%), four patients underwent RH with concurrent nodal sampling (NS) (7.8%); a total of 32 PLH were performed (62.6%).The median operative time for RRH + PLH was 255 min (range: 160-435). Pathology confirmed the adequacy of the surgical specimen. CONCLUSION: Our data support the adoption of RAL staging in patients with endometrial cancer, including those with cervical involvement, and demonstrate good long-term outcomes.

Management of hepatic rupture diagnosed after an emergency cesarean section.

A careful management of hepatic capsular rupture, with massive hemoperitoneum which occurred 14 hours after an emergency cesarean section at 36 weeks of gestation, is meticulously reported. The grade of hepatic involvement varies from minor capsular laceration to extensive parenchymal rupture. Our management involved a combination of surgical interventions and aggressive supportive care. The patient was discharged after 53 days and 4 laparotomies and an unsuccessful attempt of superselective artery embolization. Ultrasound after 40 days from the last surgery showed uniform hepatic parenchyma free of focal lesions. Due to the rarity and the unpredictability nature of this devastating event we believe necessary to report our experience, reinforcing the importance of the postsurgery management.