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Objective@#Previously, indications for laterally extended endopelvic resection (LEER) have excluded patients with sciatica because R0 resection has not been deemed possible [1].Because laparoscopy optimizes visualization and thus provides for meticulous dissection, we hypothesized that R0 resection can be achieved by means of laparoscopic LEER in patients with sciatica. This video article aimed to clarify the technical feasibility of laparoscopic LEER performed for laterally recurrent previously irradiated cervical cancer with concomitant sciatica. @*Methods@#We investigated technical feasibility of laparoscopic LEER performed as a salvage therapy following abdominal radical hysterectomy and concurrent chemoradiotherapy in a patient suffering laterally recurrent cervical carcinoma with concomitant sciatica. The recurrent tumor involved the right external and internal iliac artery and vein, ileocecum, rectosigmoid colon, right ureter, right obturator nerve, and right sciatic nerve, with a resulting fistula between the tumor and the rectosigmoid colon, and severe sciatica.Resection of all these structures was essential for achievement of R0 status, and such resection means concomitant femoral bypass with prosthetic graft interposition and gastrointestinal/urinary tract resection. @*Results@#Laparoscopic LEER with femoral-femoral artery bypass could be conducted without any postoperative complications. Pathological R0 resection could be achieved, and local recurrence could have been controlled. However, the patient died from liver and lung metastasis at 1 year after this resection surgery. @*Conclusion@#Laparoscopic LEER for a laterally recurrent previously irradiated cervical cancer with concomitant sciatica was technically feasible, however, further study involving a greater number of patients and longer follow-up period is warranted to determine the stringent indications.
RESUMO
Objective@#Previously, indications for laterally extended endopelvic resection (LEER) have excluded patients with sciatica because R0 resection has not been deemed possible [1].Because laparoscopy optimizes visualization and thus provides for meticulous dissection, we hypothesized that R0 resection can be achieved by means of laparoscopic LEER in patients with sciatica. This video article aimed to clarify the technical feasibility of laparoscopic LEER performed for laterally recurrent previously irradiated cervical cancer with concomitant sciatica. @*Methods@#We investigated technical feasibility of laparoscopic LEER performed as a salvage therapy following abdominal radical hysterectomy and concurrent chemoradiotherapy in a patient suffering laterally recurrent cervical carcinoma with concomitant sciatica. The recurrent tumor involved the right external and internal iliac artery and vein, ileocecum, rectosigmoid colon, right ureter, right obturator nerve, and right sciatic nerve, with a resulting fistula between the tumor and the rectosigmoid colon, and severe sciatica.Resection of all these structures was essential for achievement of R0 status, and such resection means concomitant femoral bypass with prosthetic graft interposition and gastrointestinal/urinary tract resection. @*Results@#Laparoscopic LEER with femoral-femoral artery bypass could be conducted without any postoperative complications. Pathological R0 resection could be achieved, and local recurrence could have been controlled. However, the patient died from liver and lung metastasis at 1 year after this resection surgery. @*Conclusion@#Laparoscopic LEER for a laterally recurrent previously irradiated cervical cancer with concomitant sciatica was technically feasible, however, further study involving a greater number of patients and longer follow-up period is warranted to determine the stringent indications.
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Port site recurrence is a rare but well-documented adverse event peculiar to laparoscopic surgery. We report an unusual outcome of unexpected early stage ovarian cancer in which port site recurrence occurred after laparoscopic surgery and was followed by diffuse subcutaneous metastases. A 31-year-old Japanese woman with a large tumor in her abdomen visited our hospital. Because no intratumoral solid component was detected on diagnostic imaging, the tumor was diagnosed as a benign ovarian tumor and the patient underwent left ovarian laparoscopic cystectomy. Contrary to our expectations, however, the ovarian tumor was a mucinous carcinoma. We performed additional surgery, but the tumor recurred in the umbilical area, and multiple subcutaneous metastases later appeared. The curative effect of chemotherapy and radiation was limited. This atypical metastatic distribution of an extremely small amount of cancer might have been caused by the laparoscopic procedure. Protection against tumor cell dissemination is necessary during all forms of laparoscopic surgery.
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We report a case of an epithelioid smooth muscle tumor of low grade malignancy, known as smooth muscle tumor of uncertain malignant potential (STUMP), in a 65-year-old woman. The patient was referred to our hospital because of an abnormal result on screening of the uterus. We initially suspected leiomyosarcoma based on the findings of preoperative medical examinations and tests, so she underwent a total abdominal hysterectomy with salpingo-oophorectomy. The final diagnosis was a tumor with a low malignant potential (STUMP).
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A 32-year-old woman underwent the laparoscopic ovarian cystectomy. During the operation, adrenaline was injected into her right ovary, because the amount of bleeding decreased. Soon after the injection, ventricular tachycardia occurred and her blood pressure increased to 190/125. The use of lidocaine induced the electrocardiogram to return to normal and brought down the blood pressure to a normal range. The operation was finished without hitch. Vasopressin has both an excellent hemostatic effect and cardiovascular side effects, and is often used at many medical facilities in Japan. But the treatment with vasopressin is neither covered by health insurance nor the relief system for sufferers from adverse drug reactions. So we usually use adrenaline which is insurable at laparoscopic operations. Adrenaline has also a hemostatic property, and causes severe cardiovascular adverse events such as ventricular tachycardia when used together with halogenated inhalation anesthetic. The Japanese Society of Anesthesiologists concludes that no serious side effects will arise from using adrenalin and sevoflurane or isoflurane based on its own findings. We had a case with ventricular tachycardia which occurred after an adrenaline local injection. But we recommend a careful use of adrenaline for local injection during a laparoscopic operation.