Isobaric laparoscopy using LaparoTenser system in surgical gynecologic oncology.

In this prospective analysis, the feasibility and outcome of isobaric laparoscopy in gynecologic oncology was evaluated. Total laparoscopic radical hysterectomy type A and B, with or without pelvic lymphadenectomy, according to the Querleu-Morrow classification was performed in 22 consecutive patients. Seven patients had early cervical cancer (adenocarcinoma stage 1B1 in 1, and squamous carcinoma stage 1B1 in 4, stage 1A2 in 1, and stage 1B2 in 1), and 15 patients had endometrial cancer (stage IA in 4, stage IB in 9, and stage IIIA in 2). Radical hysterectomy was performed using the LaparoTenser, a subcutaneous wall-lifting device. Visual analog score, duration of surgery, blood loss, complications, and postoperative course were recorded. Pathologic analysis confirmed the adequacy of the surgical specimens in type B radical hysterectomies and the number of lymph nodes removed. Low-pressure CO2 insufflation was us to improve field exposure in patients with high body mass index. Postoperatively, no patient reported substantial abdominal discomfort caused by lifting of the abdominal wall. Operative time, blood loss, and hospital stay were consistent with published data for CO2 laparoscopy. One complication related to insertion of the subcutaneous needle of the wall lifter occurred. We conclude that total laparoscopic radical hysterectomy can be successfully completed via isobaric laparoscopy using the LaparoTenser device in patients with early cervical and endometrial cancer. Gasless laparoscopy has become the first choice in our department to overcome the detrimental effects of pneumoperitoneum and represents a logical advance in the evolution of minimally invasive surgery. The LaparoTenser device is being used to perform increasingly complex procedures in high-risk patients and situations.

Robotic sacrocolpopexy for posthysterectomy vaginal vault prolapse: a case series of 31 patients by a single surgeon with a long term follow-up.

BACKGROUND: The aim of this paper was to evaluate the feasibility, short-term complications of robotic surgery and clinical outcomes in terms of long-term complications, pain relief and recurrence rate, for the treatment of vaginal vault prolapse (VVP). METHODS: Prospective analysis of robotic-assisted laparoscopic sacrocolpopexy (RALS) performed between October 2011 and February 2015, in patients with advanced post-hysterectomy VVP and significant apical defects as defined by Baden- Walker Score ≥3. RESULTS: Thirty-one consecutive of RALS were performed, with a mean follow-up of 27 months (range 2-48). Average total operative time was 185 minutes (range: 170-235). Estimated blood loss was 50 ml (range: 30-150). One case of cystotomy was reported, repaired with a 2.0 point. No others intra-operative complications occurred. Successful outcome was reported in 94% (29/31) of VVP repairs. CONCLUSIONS: This series demonstrates optimal outcomes at long-term follow-up. RALS may provide the same long-term durability of open sacrocolpopexy with the benefit of a minimally invasive approach.