RESUMEN
Robotic-assisted laparoscopic surgery is the most common approach for the treatment of early-stage endometrial and cervical cancers in the US. Surgical staging requires pelvic and often aortic lymphadenectomy, depending on the primary tumor characteristics. Pelvic and aortic lymphadenectomy procedures may also be indicated for debulking of larger metastases to improve disease control. The infra-renal basin is an important anatomic site of metastasis from pelvic tumors, and robotic dissection techniques for this site have been described. In recent years, sentinel lymph node (SLN) mapping has been adopted into the National Comprehensive Cancer Network guidelines' surgical algorithm for uterine and cervical cancers. SLN mapping has higher sensitivity for the detection of nodal metastasis, despite removing fewer lymph nodes, and potentially reduces morbidities such as lower extremity lymphedema. This article reviews current robotic pelvic and para-aortic lymphadenectomy dissection techniques for endometrial and cervical cancers and discusses the recent integration of pelvic SLN mapping in the surgical algorithm.
Asunto(s)
Neoplasias de los Genitales Femeninos/cirugía , Laparoscopía/métodos , Escisión del Ganglio Linfático/métodos , Metástasis Linfática/diagnóstico , Procedimientos Quirúrgicos Robotizados/métodos , Femenino , Neoplasias de los Genitales Femeninos/patología , Humanos , Estadificación de Neoplasias/métodos , Pelvis/patología , Pelvis/cirugía , Ganglio Linfático Centinela/patología , Ganglio Linfático Centinela/cirugía , Biopsia del Ganglio Linfático Centinela/métodosRESUMEN
Robotic-assisted laparoscopy is now the most common surgical method for treatment of early-stage endometrial, cervical, and a growing number of ovarian cancers in the U.S. Para-aortic and pelvic lymphadenectomy is integral to surgical staging and subsequent treatment planning. This article reviews current staging outcomes with robotic surgery for gynecologic cancers, and describes both trans-peritoneal, extra-peritoneal aortic dissection techniques, and the integration of pelvic sentinel lymph node mapping.
Asunto(s)
Neoplasias de los Genitales Femeninos/patología , Neoplasias de los Genitales Femeninos/cirugía , Laparoscopía/métodos , Escisión del Ganglio Linfático/métodos , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Procedimientos Quirúrgicos Robotizados/métodos , Aorta , Conversión a Cirugía Abierta/estadística & datos numéricos , Femenino , Florida , Humanos , Laparoscopía/instrumentación , Escisión del Ganglio Linfático/tendencias , Estadificación de Neoplasias , Neoplasias Ováricas/patología , Neoplasias Ováricas/cirugía , Pelvis , Peritoneo/cirugía , Procedimientos Quirúrgicos Robotizados/instrumentación , Procedimientos Quirúrgicos Robotizados/tendencias , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/cirugía , Neoplasias Uterinas/patología , Neoplasias Uterinas/cirugíaRESUMEN
Optimal protection against preventable diseases for the pregnant woman and her fetus can be provided through vaccination prior to pregnancy. When indicated, however, the benefits of immunization during pregnancy and breastfeeding may outweigh the theoretical risks of potential adverse events. Several vaccinations recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) can reduce maternal and fetal morbidity and mortality from preventable diseases. Physicians can maintain the highest standards of clinical practice by advocating for appropriate vaccinations in their female patients. The authors discuss current versions of CDC vaccination recommendations, contraindications, and precautions for pregnant and breastfeeding women.