Laparoscopic sacrocolpopexy with a vaginal prosthetic adhesive.

STUDY OBJECTIVE: To evaluate the efficacy and safety of vaginal prosthetic adhesive (VPA) during laparoscopic sacrocolpopexy. DESIGN: Retrospective analysis of 35 first consecutive cases. SETTING: Gynecology Surgery Unit, Bouchard Clinic, Marseille, France. PATIENTS: Thirty-five women (age range: 35-85 years; average 60.8 years) presenting a genital prolapse assessed by a Pelvic Organ Prolapse Quantification (POP-Q) Score (stage 2 to 4). PROCEDURES: Modified laparoscopic sacrocolpopexy using a synthetic glue (Ifabond™, Peters Surgical(®)) to fix the mesh to the vagina (anterior and posterior) and to the levator ani. Two non-absorbable knots are used to secure the anterior mesh to the isthmus and to the promontory. MEASUREMENTS AND MAIN RESULTS: The average operating time was 68.4 minutes (45-115 min). No complications occurred during the procedure and early postoperative course. One patient (2.8%) experienced mesh exposure, and one patient (2.8%) experienced a subacute intestinal obstruction, which was resolved by a medical treatment. During a median follow-up at 13.2 months (range: 6-24.7 months), the surgical success rate (POP-Q<2) was 94.2% (two recurrences). The patient satisfaction rate was 87%. CONCLUSIONS: The VPA during laparoscopic sacrocolpopexy seems to be safe and effective at short term. This new procedure due to adhesive opens up a new path for the widespread use of sacrocolpopexy and for reduced operating times, which is often one obstacle with the dissection in the development of this technique.

[Laparoscopic ways of para-aortic lymphadenectomy]. / Voie d'abord coelioscopique du curage lombo-aortique.

The idea that pelvic cancers can be treated by laparoscopy is now commonly admitted among gynaecological surgeons. Literature shows a lower morbidity than laparotomy, with similar prognostic results. Metastatic invasion of para-aortic lymph nodes is a major prognostic factor in gynaecological malignancies. It modifies the therapeutic plan and requires retroperitoneal lymphadenectomy in many indications. Laparoscopy is an interesting technical procedure in this situation: it allows both staging and curative surgery. Two laparoscopic ways are eligible: transperitoneal lymphadenectomy and retroperitoneal lymphadenectomy.

Robot-assisted laparoscopy in gynecologic oncology.

OBJECTIVES: The aim of this prospective study was to evaluate the feasibility and the outcome of gynaecological cancer surgery with the Da Vinci S surgical system (Intuitive Surgical). METHODS: From February 2007 to September 2007, 28 patients underwent 32 gynaecological procedures in a single centre. Surgical procedures consisted of total hysterectomy, bilateral oophorectomy, and pelvic and/or lombo-aortic lymphadenectomy. In all cases, surgery was performed using both laparoscopic and robot-assisted laparoscopic techniques. In this heterogeneous series, a subgroup of 12 patients treated for advanced cervical cancer was compared with a retrospective series of 20 patients who underwent the same surgical procedure by laparotomy. RESULTS: Mean age of the entire population was 52.5 years (range 25-72 years) and mean body mass index (BMI) was 25 kg/m(2) (range 18-40 kg/m(2)). Indications for surgery were cervical cancer in 21 cases, endometrial cancer in 7 cases, ovarian cancer in 1 case and cervical dysplasia in 3 cases. Median operating time was 180 min (mean 175.25 min, range 80-360 min) and median estimated blood loss was 110 cc (range 0-400 cc); no transfusions were necessary. No perioperative complications were observed and median time of hospitalisation was 3 days (mean 3.9 days, range 2-8 days). In the subgroup of 12 advanced cervical cancer a significant difference was observed in terms of hospital stay compared with laparotomy; no difference was observed concerning operative time. Fewer complications were observed with laparotomy (33% versus 25%) but more serious complications than with robot-assisted laparoscopy. CONCLUSION: As suggested in the literature, the use of robot-assisted laparoscopy leads to less intraoperative blood loss, less post operative pain and shorter hospital stays compared with those treated by more traditional surgical approaches. Despite the need for more extensive studies, robot-assisted surgery seems to represent a similar technological evolution as the laparoscopic approach 50 years ago.