Robotic-Assisted Video Endoscopic Inguinal Lymphadenectomy in Carcinoma Vulva: Our Experiences and Intermediate Results.

OBJECTIVES: To describe the technique of robotic-assisted video endoscopic inguinal lymphadenectomy (R-VEIL) in patients with carcinoma vulva and discuss the advantages of the technique and oncological outcome. METHODS: Twelve patients of squamous cell cancer of vulva underwent 22 R-VEIL procedures from February 2011 to February 2015. Their preoperative, intraoperative, and postoperative data were retrospectively analysed. RESULTS: The mean age of patients was 61 years (range, 32-78 years). The mean operative time was 69.3 minutes (range, 45-95 minutes). The mean blood loss was 30 mL (range, 15-50 mL). No intraoperative complication was observed. The mean drain output was 119 mL (range, 50-250 mL), and the drains were removed at a mean of 13.9 days (range, 8-38 days). The average number of superficial and deep inguinofemoral lymph nodes retrieved was 11 (range, 4-26). Two patients had positive lymph nodes on histopathology (16.67%). Postoperative complications were lymphocele (6 groins), chronic lower limb lymphedema (6 cases), prolonged lymphorrhea (1 groin), and cellulitis (2 groins). Over a follow-up period ranging from 7 to 67 months, 1 patient developed recurrence in the inguinal nodes and died 7 months after the recurrence. CONCLUSIONS: The R-VEIL allows the removal of inguinal lymph nodes within the same limits as the open procedure for inguinal lymph node dissection and has a potential to reduce the surgical morbidity associated with the open procedure. Long-term oncological results are not available though our initial results appear promising. Prospective multi-institutional studies are required to prove its efficacy over open inguinal lymph node dissection.

Presentation and Management of Inguinal Lymphadenopathy in Ovarian Cancer.

The symptoms in ovarian cancer are often missed leading to dubious diagnosis and staging. Inguinal lymphadenopathy (ILAP) is reported to be rare and occurring via lymphatic or hematogenous route. The paucity of studies on ILAP in ovarian cancer indicates a scope of refining its staging and management. The present study aims to document the presentation and management of ILAP in ovarian cancer, which may also reflect its incidence and mechanism of spread. All patients of ovarian cancer with inguinal lymphadenopathy presenting to our institute from 1 January 2015 to 31 December 2015 were included. All clinical, treatment, and pathological details were analyzed. Seven patients of ovarian cancer presented with ILAP. The mean age and BMI were 53.29 +/- 8.38 years and 26.23 +/- 3.03 kg/m2. Presentation varied from advanced disease (adnexal, omental, peritoneal, and nodal) to isolated ILAP even without adnexal mass (n = 4). Mean CA 125 was 229.64 +/- 322 (20-924) and ovarian primary was confirmed on microscopy or immunohistochemistry. Six patients underwent surgery with (n = 4) or without neoadjuvant chemotherapy (n = 2). Complete cytoreduction could be achieved in all patients with acceptable operative and perioperative outcomes. Peritoneal surface spread, along hernia track to the groin, was seen in two patients. Histopathology showed advanced disease, isolated ILAP and no residual disease in 3, 2, and 1 patient, respectively. ILAP has diverse clinical presentation in ovarian cancers and is not that uncommon. ILAP may also occur by peritoneal surface spread and shows good results with cytoreductive surgery and chemotherapy.

Role of Radical Surgery in Early Stages of Vaginal Cancer-Our Experience.

OBJECTIVES: The objective of our present study was to evaluate the efficacy of radical vaginectomy with or without radical hysterectomy in patients with International Federation of Gynecology and Obstetrics stage I and II vaginal cancers. MATERIALS AND METHODS: A retrospective study was carried out on 11 patients aged 35 to 78 years. All the patients underwent radical surgery for vaginal cancer from April 2010 till June 2015. Kaplan-Meier analyses were used to calculate the disease-free survival and overall survival at 12 months. RESULTS: The mean age of patients was 53.2 years. Ten patients were with International Federation of Gynecology and Obstetrics stage I, whereas one had stage II vaginal cancer. The histology was squamous cell cancer in 9 patients and small cell neuroendocrine cancer in 2 patients. The lesion was confined to the upper two third of the vagina in 8 cases, and the lower one third was involved in 3 cases. All the patients underwent radical surgery. Lymph node dissection was done in 9 patients out of whom lymph nodes were positive in 3 patients. Two patients had positive margins. Adjuvant treatment was given to patients with positive margins or positive nodes. Five patients did not require any adjuvant treatment, and 1 patient defaulted adjuvant treatment. One patient developed vesicovaginal fistula. Over a follow-up period ranging from 5 to 67 months, local recurrence developed in 1 patient, whereas no patient died of disease. One patient was lost to follow-up at 15 months. The 12-month disease-free survival was 88.9%, and 12-month overall survival was 100%. CONCLUSIONS: Stage I and selected stage II vaginal cancer patients have good outcomes in terms of survival and local tumor control if managed judiciously by initial surgery followed by selective adjuvant therapy.

Determinants of rupture of the unscarred uterus and the related feto-maternal outcome: current scenario in a low-income country.

BACKGROUND: Rupture of the gravid uterus is one of the most grievous obstetric events accounting for considerable maternal morbidity and mortality. MATERIALS AND METHODS: An audit over a period of 2 years from October 2010 to September 2012 was performed on pregnant women irrespective of gestational age who had a uterine rupture of a uterus, presumed to be unscarred. RESULTS: There were 141 ruptures among 43,886 deliveries (0.3%). Of those, 18 (12.8% of the ruptures and 0.04% of the deliveries) occurred in presumed unscarred uteri. The aetiologies were: obstruction 50%, uterine anomaly 22.2%, oxytocic administration 16.6 %, instrumental deliveries 5.5% and miscellaneous 11.1 %. Hysterectomy was performed in 55.6% of cases. Fetal mortality was 83.3% and maternal mortality was 16.6%. CONCLUSIONS: Training of traditional birth attendants for early referrals, screening for uterine anomalies by ultrasound in early pregnancy and counselling the women, especially multiparas and grand-multiparas are mandatory. Oxytocin should only be used for those if the doctor who prescribed its use stays with the patient continuously and stops oxytocics as soon as there are reasonable contractions. In emergency, the decision to delivery time should be less than 30 min. These are some ways through which a tragic event like uterine rupture and its consequences can be averted.