Dellinger Thanh H, Wakabayashi Mark T, Han Ernest S
Division of Gynecologic Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California.
Division of Gynecologic Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California.
J Minim Invasive Gynecol. 2017 May-Jun;24(4):531-532. doi: 10.1016/j.jmig.2016.10.010. Epub 2016 Oct 26.
To demonstrate the feasibility of multiquadrant staging of a uterine carcinosarcoma using the latest-generation robotic platform.
Step-by-step explanation of the technique using videos and pictures (educative video).
Although laparoscopic and robotic-assisted laparoscopic staging of high-risk uterine cancer is well incorporated into many gynecologic oncology practices, extensive para-aortic lymphadenectomies above the inferior mesenteric artery are less commonly performed. Additionally, infracolic omentectomies are frequently performed in lieu of infragastric omentectomies.
A 67-year-old woman with a newly diagnosed uterine carcinosarcoma.
Multiquadrant comprehensive staging of uterine carcinosarcoma using the latest-generation robotic platform.
We demonstrate in this video a facile approach for robotic surgeons to perform an extensive para-aortic lymphadenectomy up to the renal vessels, as well an infragastric omentectomy, using the latest-generation multiquadrant robotic platform. This platform allows for facile rotation from an upper abdominal view to perform the para-aortic lymphadenectomy and omentectomy, to a pelvic view to complete the pelvic lymphadenectomies, hysterectomy and bilateral salpingo-oophorectomy. We demonstrate this technique in a 67-year-old woman with a newly diagnosed uterine carcinosarcoma who underwent a robotic-assisted laparoscopic total hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic and para-aortic lymphadenectomy, and infragastric omentectomy via the Xi Da Vinci Robot (Intuitive Surgical, Sunnyvale, CA). Total operative time was 280 minutes (50 minutes for the omentectomy, 86 minutes for the para-aortic lymphadenectomy). Estimated blood loss was 50 mL. Final pathology revealed a stage IA uterine carcinosarcoma; a total of 27 para-aortic lymph nodes and 20 pelvic lymph nodes were removed, and the size of the excised omentum was 68 × 10 × 1.2 cm.
The technique of using alternating dual perspectives (upper abdominal or pelvic views) through a multiquadrant robotic platform enables the robotic surgeon to perform extensive para-aortic lymphadenectomies and omentectomies without resorting to laparoscopic surgery to complete these procedures.
利用最新一代机器人平台演示子宫癌肉瘤多象限分期的可行性。
通过视频和图片对该技术进行逐步讲解（教育视频）。
虽然腹腔镜及机器人辅助腹腔镜下高危子宫癌分期已很好地纳入许多妇科肿瘤治疗实践中，但肠系膜下动脉水平以上广泛的腹主动脉旁淋巴结清扫术较少进行。此外，经常进行结肠下网膜切除术而非胃下网膜切除术。
一名67岁新诊断为子宫癌肉瘤的女性。
使用最新一代机器人平台对子宫癌肉瘤进行多象限全面分期。
在本视频中，我们展示了一种简便的方法，让机器人手术医生使用最新一代多象限机器人平台进行至肾血管水平的广泛腹主动脉旁淋巴结清扫术以及胃下网膜切除术。该平台允许轻松地从上腹部视野旋转至进行腹主动脉旁淋巴结清扫术和网膜切除术，再转至盆腔视野以完成盆腔淋巴结清扫术、子宫切除术和双侧输卵管卵巢切除术。我们在一名67岁新诊断为子宫癌肉瘤的女性患者身上演示了该技术，该患者通过Xi达芬奇机器人（直观外科公司，加利福尼亚州森尼韦尔市）接受了机器人辅助腹腔镜下全子宫切除术、双侧输卵管卵巢切除术、双侧盆腔及腹主动脉旁淋巴结清扫术以及胃下网膜切除术。总手术时间为280分钟（网膜切除术50分钟，腹主动脉旁淋巴结清扫术86分钟）。估计失血量为50毫升。最终病理显示为IA期子宫癌肉瘤；共切除27个腹主动脉旁淋巴结和20个盆腔淋巴结，切除的网膜大小为68×10×1.2厘米。
通过多象限机器人平台交替使用双视角（上腹部或盆腔视野）的技术，使机器人手术医生能够进行广泛的腹主动脉旁淋巴结清扫术和网膜切除术，而无需借助腹腔镜手术来完成这些操作。
