Barnes Hayley, Harrison Ross, Huffman Laura, Medlin Erin, Spencer Ryan, Al-Niaimi Ahmed
Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin.
Department of Obstetrics and Gynecology, University of Louisville, Louisville, Kentucky.
J Minim Invasive Gynecol. 2017 Sep-Oct;24(6):1029-1036. doi: 10.1016/j.jmig.2017.06.017. Epub 2017 Jun 27.
To study the safety, feasibility, learning curve, and surgical outcome for single-port laparoscopic full staging of endometrial cancer.
A retrospective study (Canadian Task Force classification II-3).
A university academic hospital.
Women with endometrial cancer undergoing single-port laparoscopic full surgical staging.
This was a single-center, retrospective consecutive study of patients undergoing single-port laparoscopic full staging of endometrial cancer from March 2012 to December 2015.
One hundred ten consecutive cases were included in the study. The mean age was 63 years (standard deviation = 14), and the mean body mass index was 34 kg/m (standard deviation = 7). Medical comorbidity was noted in 62% (68/110) of patients, and 55% (61/110) of patients had previous abdominal surgery. Preoperative histology included grade 1 (63%), grade 2 (23%), grade 3 (4%), papillary serous (6%), clear cell (3%), and mixed (1%). Postoperatively, 73% of patients were stage I, 2% were stage II, 21% were stage III, and 4% were stage IV. The conversion rate to multiple ports or to laparotomy was 6.3%. The average total surgical time was 186 minutes. Comparing the last 30 cases of our cohort with the first 20, there was a significant improvement in the reduction of the total operative time (191 vs 152 minutes, p = .036), estimated blood loss (389 vs 121 mL, p = .002), conversion rate (20 % vs 0%, p = .02), and rate of surgical complication (10% vs. 0%, p = .03). The readmission rate was 11% (12/110) with 75% of those patients being readmitted for surgical indications and 25% for medical indications. The rate of ventral hernia was 1.8% (2/110) with an average follow-up of 298 days (31-1085 days).
Single-port laparoscopic staging of endometrial cancer is a safe and feasible technique to introduce into a gynecologic oncology practice that is compatible with other minimally invasive modalities with similar complication rates, discharge timing, and operative times. Drastic improvement in surgical time can be seen after approximately the first 20 cases.
研究单孔腹腔镜子宫内膜癌全面分期手术的安全性、可行性、学习曲线及手术效果。
一项回顾性研究（加拿大工作组分类II-3）。
一所大学附属医院。
接受单孔腹腔镜子宫内膜癌全面分期手术的女性患者。
这是一项单中心回顾性连续研究，纳入了2012年3月至2015年12月期间接受单孔腹腔镜子宫内膜癌全面分期手术的患者。
共纳入连续110例病例。平均年龄为63岁（标准差=14），平均体重指数为34kg/m²（标准差=7）。62%（68/110）的患者有内科合并症，55%（61/110）的患者既往有腹部手术史。术前组织学类型包括1级（63%）、2级（23%）、3级（4%）、乳头状浆液性（6%）、透明细胞（3%）和混合型（1%）。术后，73%的患者为I期，2%为II期，21%为III期，4%为IV期。转为多孔或开腹手术的比例为6.3%。平均总手术时间为186分钟。将本队列的最后30例与前20例进行比较，发现总手术时间（191分钟对152分钟，p=0.036）、估计失血量（389ml对121ml，p=0.002）、中转率（20%对0%，p=0.02）和手术并发症发生率（10%对0%，p=0.03）均有显著改善。再入院率为11%（12/110），其中75%的患者因手术指征再次入院，25%因内科指征再次入院。腹疝发生率为1.8%（2/110），平均随访298天（31-1085天）。
单孔腹腔镜子宫内膜癌分期手术是一种安全可行的技术，可引入妇科肿瘤学实践，其并发症发生率、出院时间和手术时间与其他微创方式相似。在前20例左右的病例之后，手术时间可显著缩短。
