RESUMEN
OBJECTIVE: To evaluate the place of laparoscopy in hysterectomy. DESIGN: A retrospective study. SETTING: Département de Gynécologie Obstétrique et Reproduction Humaine. Polyclinique de l'Hôtel-Dieu-CHU de Clermont-Ferrand. SUBJECTS: A 318 cases continuous series of laparoscopic hysterectomies performed from 1989 to 1993. Results were presented and compared to the largest series of vaginal or abdominal hysterectomies reported in the literature. RESULTS: Conversion to a vaginal route or a laparotomy was required in 11.3% of the cases. Operative duration was longer with laparoscopy than with the other technique. But hospital stay was shorter. The complications were extremely rare after laparoscopic hysterectomy. Urological complications rate was high. Operative route remains a controversial question. CONCLUSION: Laparoscopy has become the routine procedure for hysterectomy in our department.
Asunto(s)
Histerectomía/métodos , Laparoscopía/métodos , Enfermedades Uterinas/cirugía , Femenino , Humanos , Histerectomía/efectos adversos , Laparoscopía/efectos adversos , Tiempo de Internación , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Enfermedades Uterinas/patologíaAsunto(s)
Infecciones por Deltaretrovirus/epidemiología , Infecciones por VIH/epidemiología , Seroprevalencia de VIH , Complicaciones Infecciosas del Embarazo/epidemiología , Donantes de Sangre , Anticuerpos Antideltaretrovirus/sangre , Femenino , Gabón/epidemiología , Humanos , Masculino , EmbarazoRESUMEN
As a result of recent technological advances, laparoscopic lymphadenectomy is becoming the standard method for the staging of pelvic cancer. More extensive procedures, such as para-aortic lymph node dissection and radical hysterectomy, have also been demonstrated to be feasible by advanced laparoscopic surgery. This new approach appears to be very promising. In the future, because of its well documented advantages, laparoscopic surgery may appear as a way to decrease the morbidity of cancer treatment in patients with low-risk tumors and to propose more aggressive treatments of patients with tumors associated with a poor prognosis. These new techniques should be reserved for surgical teams trained in oncologic and major laparoscopic surgery. More clinical research is required before this approach can be proposed as an alternative to laparotomy, and guidelines have to be established. Training in oncology is essential to ensure optimal patient care and to avoid the consequences of inadequate laparoscopic management with regard to cases of tumor dissemination reported after laparoscopic biopsy or resection of undiagnosed ovarian cancer.
Asunto(s)
Neoplasias de los Genitales Femeninos/cirugía , Laparoscopía , Neoplasias Endometriales/cirugía , Neoplasias de las Trompas Uterinas/cirugía , Femenino , Humanos , Histerectomía , Escisión del Ganglio Linfático , Neoplasias Ováricas/cirugía , Neoplasias del Cuello Uterino/cirugía , Neoplasias Uterinas/cirugíaRESUMEN
A laparoscopic approach for radical hysterectomy is described. The laparoscopic procedures are similar to those achieved previously by laparotomy, the extent of surgery being adapted to the volume of the tumour and to the associated treatments. From the results obtained in a preliminary study of 15 patients, this approach appears to be safe. This surgical treatment of cervical cancer which associates a radical procedure complying with oncological rules with a decreased morbidity seems very promising. However, laparoscopic radical hysterectomy should be considered investigational and reserved for oncology surgeons trained in extensive laparoscopic procedures. Large studies with long follow-up are necessary before this approach can be proposed as an alternative to conventional surgical approaches.