Volpi Eugenio, Bernardini Luca, Ferrero Anna Maria
Department of Obstetrics and Gynecology, Saint Andrew Hospital Asl 5, La Spezia, Italy.
Int J Surg Oncol. 2012;2012:263850. doi: 10.1155/2012/263850. Epub 2012 Jul 13.
Introduction. We retrospectively report our experience with the utilization of an original procedure for total laparoscopic hysterectomy based on completely retrograde and retroperitoneal technique for surgical staging and treatment of the endometrial cancer. The surgical, financial, and oncological advantages are here discussed. Methods. The technique used here has been based on a combination of a retroperitoneal approach with a retrograde and lateral dissection of the bladder and retrograde culdotomy with variable resection of parametrium. No disposable instruments and no uterine manipulator were utilized. Results. Intraoperative and postoperative complications were observed in 10% of the cases overall. Operative time length and mean haemoglobin drop value results were 129 min and 125 mL, respectively. Most patients were dismissed on days 3-5 from the hospital. Seventy-eight percent of the patients were alive with no evidence of disease at mean followup of 49 months. Conclusions. Our original laparoscopic technique is based on a retroperitoneal approach in order to rapidly control main uterine vessels coagulation, constantly check the ureter, and eventually decide type and site of lymph nodes removal. This procedure has important cost saving implications and the avoidance of uterine manipulator is of matter in case such as these of uterine malignancy.
引言。我们回顾性报告了我们采用一种基于完全逆行和腹膜后技术的全腹腔镜子宫切除术的原始手术方法用于子宫内膜癌手术分期和治疗的经验。本文讨论了该手术在手术、经济和肿瘤学方面的优势。方法。这里所采用的技术是将腹膜后入路与膀胱的逆行和外侧分离以及可变范围切除子宫旁组织的逆行阴道后穹窿切开术相结合。未使用一次性器械和子宫操纵器。结果。总体上，10%的病例观察到术中及术后并发症。手术时间长度和平均血红蛋白下降值分别为129分钟和125毫升。大多数患者在术后3 - 5天出院。在平均49个月的随访中，78%的患者存活且无疾病证据。结论。我们的原始腹腔镜技术基于腹膜后入路，以便快速控制子宫主要血管的凝血，持续检查输尿管，并最终决定淋巴结切除的类型和部位。该手术方法具有重要的成本节约意义，并且在子宫恶性肿瘤等情况下避免使用子宫操纵器至关重要。
