Comparison of robotic-assisted and conventional laparoscopy in the management of adnexal masses.

STUDY OBJECTIVE: To compare the outcome of robotic-assisted laparoscopy vs conventional laparoscopy in the management of ovarian masses. DESIGN: Retrospective cohort (Canadian Task Force classification II-3). SETTING: Academic medical centre in the northeast United States. PATIENTS: Retrospective medical record review of 71 consecutive patients with presumed benign ovarian masses. INTERVENTION: Robotic-assisted laparoscopy in 30 patients with presumed benign ovarian masses was compared with conventional laparoscopy in 41 patients. MEASUREMENTS AND MAIN RESULTS: Operative outcomes including operative time, estimated blood loss, length of hospital stay, and complications were recorded. Standard statistical analysis was used to compare the outcomes in the 2 groups. Mean (SD) operative time in the robotic group was 1.95 (0.63) hours, which was significantly longer than in the conventional laparoscopic group, 1.28 (0.83) hours (p = .04). Estimated blood loss in the robotic group was 74.52 (56.23) mL, which was not significantly different from that in the conventional laparoscopic group, 55.97 (49.18) mL. There were no significant differences in length of hospital stay between the robotic and conventional laparoscopic groups: 1.20 (0.78) days and 1.48 (0.63). Conversion to laparotomy was not necessary in either group of patients. Intraoperative and postoperative complications were similar between the 2 groups. CONCLUSION: Robotic-assisted laparoscopy is a safe and efficient technique for management of various types of ovarian masses. However, conventional laparoscopy is preferred for management of ovarian masses because of shorter operative time. Prospective studies are needed to evaluate the outcomes of robotic-assisted laparoscopic management of benign and malignant ovarian neoplasms.

A case-controlled study of total laparoscopic radical hysterectomy with pelvic lymphadenectomy versus radical abdominal hysterectomy in a fellowship training program.

To determine whether total laparoscopic radical hysterectomy (TLRH) is a feasible alternative to an abdominal radical hysterectomy (ARH) in a gynecologic oncology fellowship training program. We prospectively collected cases of all of the patients with cervical cancer treated with TLRH and pelvic lymphadenectomy by our division from 2000 to 2006. All of the patients from the TLRH group were matched 1:1 with the patients who had ARH during the same period based on stage, age, histological subtype, and nodal status. Thirty patients were treated with TLRH with a mean age of 48.3 years (range, 29-78 years). The mean pelvic lymph node count was 31 (range, 10-61) in the TLRH group versus 21.8 (range, 8-42) (P < 0.01) in the ARH group. Mean estimated blood loss was 200 cc (range, 100-600 cc) in the TLRH with no transfusions compared to 520 cc in the ARH group (P < 0.01), in which five patients required transfusions. Mean operating time was 318.5 min (range, 200-464 min) compared to 242.5 min in the ARH group (P < 0.01), and mean hospital stay was 3.8 days (range, 2-11 days) compared to 5.6 days in the ARH group (P < 0.01). All TLRH cases were completed laparoscopically. All patients in the TLRH group are disease free at the time of this report. In conclusion, it is feasible to incorporate TLRH training into the surgical curriculum of gynecologic oncology fellows without increasing perioperative morbidity. Standardization of TLRH technique and consistent guidance by experienced faculty is imperative.

Malignant pericardial effusion with cardiac tamponade in a patient with metastatic vaginal adenocarcinoma.

Malignant pericardial effusion with cardiac tamponade is a rare manifestation of metastatic gynecological cancer. A 35-year-old female was diagnosed with clear cell adenocarcinoma of the vagina. Four years after partial vaginectomy, she developed regional recurrence and was treated with surgical excision followed by platinum-based chemotherapy and radiation therapy. Six years later, the patient was diagnosed with lung metastases and received a combination adriamycin and platinum-based chemotherapy. Shortly after completing treatment, she presented with weakness and was found to be hypotensive on physical exam. Computed tomography scan confirmed a pericardial effusion with evidence of bilateral heart failure. She underwent an emergent pericardiocentesis and eventual pericardial window procedure. Metastatic adenocarcinoma of the vagina can present with malignant pericardial effusion with cardiac tamponade. Therefore, gynecologists and gynecological oncologists need to be familiar with the diagnosis and management of this disease process.

Bilateral pelvic lymph node metastases in a case of FIGO stage IA(1) adenocarcinoma of the cervix.

INTRODUCTION: Although the FIGO staging system has been recently described for microinvasive adenocarcinoma of the cervix, the precise role it will have on determining how patients are treated remains uncertain. Using various definitions for the classification of microinvasion, recent reports have suggested conservative management for patients with this disease. CASE: We present the case of a 62-year-old woman with FIGO stage IA(1) adenocarcinoma of the cervix found to have bilateral microscopic pelvic lymph node metastases. To our knowledge, this is the only documented case of lymph node metastases in a patient with IA(1) disease. CONCLUSIONS: A review of the controversial issues involving the definition and management of microinvasive adenocarcinoma of the cervix is presented. The finding of lymph node metastases in our patient provides support for aggressive surgical management in selected patients with this disease.

Prenatal diagnosis of mosaic tetrasomy 21q confirmed by fluorescence in situ hybridization.

We describe the first case of a live-born neonate with mosaic tetrasomy 21q confirmed by fluorescence in situ hybridization (FISH). A 38-year-old Caucasian female presented for amniocentesis for maternal age. Initial chromosome analysis of the amniocytes using GTG-banding showed a mos47,XY, +?i(12p)/46,XY karyotype. Follow-up studies with FISH identified the isochromosome as an i(21q); mos47,XY, +i(21q)/46,XY. The patient was delivered at 38+ weeks gestation and umbilical cord blood samples were obtained. Chromosome analysis of 43 cord blood lymphocytes demonstrated a 46,XY karyotype in all cells. However, peripheral lymphocytes taken 1 day after birth showed 1 out of 120 lymphocytes to have an extra chromosome determined to be an i(21q). While initial clinical exam of the neonate revealed similarities to Down syndrome, long-term follow up of our patient will be required to provide the first definitive description of the mosaic tetrasomy 21 syndrome.