Upper para-aortic lymph node dissection (PALND) is one of the most challenging gynecologic robotic procedures. This study aimed to evaluate the oncologic and operative outcomes of robotic staging surgery, including upper PALND, using low pelvic port placement (LP3) in 22 patients with high-risk endometrial cancer. High-risk was defined as patients who showed deep myometrial invasion with grade III, cervical involvement, or high-risk histology. The mean patient age and body mass index were 58 years and 24 kg/m2. The mean operative time was 263 min. The mean number of total LNs and upper PALNs obtained was 31 and 10. Two patients received lymphangiography to reduce the amount of drained lymphatic fluid after surgery. The recurrence rate was 13.6% (3/22). There were two LN recurrences and one at the peritoneum in the intra-abdominal cavity. Robotic staging surgery using LP3 was feasible for performing PALND as well as procedures in the pelvic cavity simultaneously. It provides important techniques for performing optimal surgical procedures when surgeons decide to perform comprehensive PALND in instances of isolated recurrence or unexpected LN enlargement as well as high-risk endometrial cancer. Consequently, surgeons can achieve surgical consistency and reproducibility for PALND, leading to improved operative and survival outcomes in high-risk endometrial cancer.
Objective: Upper paraaortic lymph node dissection (UPALD) to the infrarenal level is one of the most challenging robotic procedures.Because robotic system has the limitation in robotic arm mobility.This surgical video introduces a novel robotic approach, lower pelvic port placement (LP3), to perform optimally and simultaneously both UPALD and pelvic procedures in gynecologic cancer patients using da Vinci Xi system.Methods: The patient presented with high-grade endometrial cancer.She underwent robotic surgical staging operation.For the setup of the LP3, a line was drown between both anterior superior iliac spines.At 3 cm below this line, another line was drown and four robotic ports were placed on this line.Results: After paraaortic lymph node dissection (PALD) was completed, the boom of robotic system was rotated 180° to retarget for the pelvic lateral displacement.Robotic ports were placed and docked again.The operation was completed robotically without any complication. Conclusion:The LP3 was feasible for performing simultaneously optimal PALD as well as procedures in pelvic cavity in gynecologic cancer patients.The advantage of LP3 technique is the robotic port placement that affords for multi-quadrant surgery, abdominal and pelvic dissection.The LP3 is facilitated by utilizing advanced technology of Xi system, including the patient clearance function, the rotating boom, and 'port hopping' that allows using every ports for a camera.The LP3 will enable surgeons to extend the surgical indication of robotic surgical system in the gynecologic oncologic field.
Objective: To evaluate the efficacy of combined oral medroxyprogesterone acetate (MPA)/ levonorgestrel-intrauterine system (LNG-IUS) treatment and to compare the diagnostic accuracy of endometrial aspiration biopsy with dilatation & curettage (D&C) in young women with early-stage endometrial cancer (EC) who wished to preserve their fertility.Methods: A prospective phase II multicenter study was conducted from January 2012 to January 2017.Patients with grade 1 endometrioid adenocarcinoma confined to the endometrium were treated with combined oral MPA (500 mg/day)/LNG-IUS.At 3 and 6 months of treatment, the histologic change of the endometrial tissue was assessed.The regression rate at 6 months treatment and the consistency of the histologic results between the aspiration biopsy and the D&C were evaluated.Results: Forty-four patients were enrolled.Nine voluntarily withdrew and 35 patients completed the protocol treatment.The complete regression (CR) rate at 6 months was 37.1% (13/35).Partial response was shown in 25.7% of cases (9/35).There were no cases of progressive disease and no treatment-related complications.A comparison of the pathologic results from aspiration biopsy and D&C was carried out for 33 cases.Fifteen cases were
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