Tinelli Raffaele, Dellino Miriam, Nappi Luigi, Sorrentino Felice, D'Alterio Maurizio Nicola, Angioni Stefano, Bogani Giorgio, Pisconti Salvatore, Uccella Stefano, Silvestris Erica
Department of Obstetrics and Gynecology, "Valle d'Itria" Hospital, Martina Franca, Taranto, Italy.
Department of Gynecology Oncology, "Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giovanni Paolo II", Bari, Italy.
Front Surg. 2022 Mar 9;9:843641. doi: 10.3389/fsurg.2022.843641. eCollection 2022.
Laparoscopic surgical staging is the standard treatment of early-stage ovarian tumors with similar survival outcomes if compared with laparotomic procedures. In this article, we report a case regarding an incidental external iliac vein injury during a pelvic lymphadenectomy for fertility sparing treatment of early-stage ovarian cancer with a video showing the laparoscopic repair without any consequence or side effect. A 36 year-old obese woman with Body Mass Index 30 kg/m referred at our hospital with an histological diagnosis of high grade ovarian serous carcinoma after a left laparoscopic salpingo-oophorectomy performed in another hospital. After an hysteroscopy with endometrial biopsy, a laparoscopic surgical staging with a pelvic and aortic lymphadenectomy with lymph-node dissection until the left renal vein, omentectomy, and appendectomy were performed. A thermal injury to the left external iliac vein occurred using the bipolar forceps during lymphadenectomy and was repaired after an immediate clamping of the site using endoclinch and the suction irrigator probe. The laceration on the iliac vein was successfully repaired using 10 mm laparoscopic titanium clips; after a follow-up of 42 months no recurrence was detected. In conclusion, laparoscopy is a safe and effective therapeutic option for fertility sparing treatment patients with early stage ovarian carcinoma with a significantly low morbidity and postoperative hospitalization, but it should be reserved for oncologic surgeons trained in advanced laparoscopic procedures and repair of vascular injuries potentially associated with high mortality rate.
腹腔镜手术分期是早期卵巢肿瘤的标准治疗方法，与开腹手术相比，其生存结果相似。在本文中，我们报告了一例在早期卵巢癌保留生育功能治疗的盆腔淋巴结清扫术中意外发生髂外静脉损伤的病例，并配有一段视频展示了腹腔镜修复过程，未产生任何后果或副作用。一名36岁、体重指数为30kg/m²的肥胖女性，在另一家医院接受左侧腹腔镜输卵管卵巢切除术后，被转诊至我院，经组织学诊断为高级别卵巢浆液性癌。在进行宫腔镜检查及子宫内膜活检后，实施了腹腔镜手术分期，包括盆腔和主动脉淋巴结清扫，清扫范围至左肾静脉水平，同时进行了大网膜切除术和阑尾切除术。在淋巴结清扫过程中，使用双极电镊时导致左髂外静脉热损伤，立即使用血管夹和吸引冲洗探头对损伤部位进行夹闭后进行了修复。使用10mm腹腔镜钛夹成功修复了髂静脉撕裂伤；经过42个月的随访，未发现复发。总之，腹腔镜手术对于早期卵巢癌保留生育功能治疗的患者是一种安全有效的治疗选择，其发病率和术后住院时间显著较低，但应仅由接受过高级腹腔镜手术及可能与高死亡率相关的血管损伤修复培训的肿瘤外科医生实施。
