[Preliminary study on laparoscopically robotic assisted radical hysterectomy and pelvic lymphadenectomy on cervical cancer.].

OBJECTIVE: To evaluate the feasibility of laparoscopically robotic assisted radical hysterectomy and pelvic lymphadenectomy in treatment of cervical cancer. METHODS: From Dec. 2008 to Aug. 2009, 5 cervical cancer patients at stage Ib1 to IIa underwent laparoscopically robotic assisted radical hysterectomy and pelvic lymphadenectomy. The following clinical parameters were recorded and compared, including operative time, blood loss, intraoperative and postoperative complications, the changes of hemoglobin before and after surgery, postoperative temperature, the time of postoperative anus exhaust and urination, hospitalization, pathologic exam, and the number of lymph nodes. RESULTS: Laparoscopically robotic assisted radical hysterectomy and pelvic lymphadenectomy were performed successfully on those 5 patients without the conversion to laparotomy. No intraoperative and postoperative complications were observed. The operative time were 305, 365, 275, 240 and 245 minutes, respectively, with a mean value of 286 minutes. Estimated blood loss was 200, 400, 650, 300 and 400 ml, respectively. The mean blood loss was 390 ml. Temperatures of all patients were not higher than 37.5 degrees C and anus exhaust was recovered at 36 hours after surgery. Those five patients were hospitalized for 11, 13, 9, 12 and 12 days respectively. Squamous carcinoma of cervix were diagnosed by the pathologic examination. The resected margin of vagina and parametrium was clear. The numbers of pelvic lymph nodes were 14, 22, 16, 21 and 18, respectively. No evidence of lymph nodes metastasis was found. CONCLUSION: Laparoscopically robotic assisted radical hysterectomy and pelvic lymphadenectomy is feasible as a novel approach in the treatment of cervical cancer.

[Method of anesthesia and perioperative management for off-pump coronary artery bypass grafting].

OBJECTIVE: To investigate the method of anesthesia and perioperative management for off- pump coronary artery bypass grafting (OPCABG), and to examine the hemodynamic changes during the operation. METHODS: One hundred and thirteen patients undergoing OPCABG were studied. Anesthesia induction was achieved by giving midazolam 0.05 mg/kg, ketamine 0.5 mg/kg, vecuronium 0.13-0.15 mg/kg and fentanyl 5-10 microg/kg. Vecuronium and fentanyl were given as needed, isoflurane and propofol were administered for maintenance. Hemodynamic indexes, ST-segment change in electrocardiogram (ECG) and lidocaine's influence to the cardiac rhythm were observed and recorded during the main process of operation. RESULTS: Observation before and during the operation showed that mean arterial pressure (MAP) and heart rate (HR) decreased a little but within clinical acceptable range, at the beginning, and it recovered soon. The result of rate-pressure product (RPP) showed that the reduction of cardiac muscle oxygen consumption was satisfactory. There was no significant change in ST-segment in ECG (P>0.05) before and during the main procedure. Giving 1 mg/kg lidocaine before the operation could obviously lower the possibility or degree of premature ventricular extrasystole. CONCLUSION: OPCABG can be performed safely under the above method of anesthesia. The perioperative management is effective and satisfactory in maintaining stable circulation and in keeping oxygen supply and consumption balance.