Total laparoscopic radical hysterectomy (type III) and pelvic lymphadenectomy.

A case of Stage IIA, G2 carcinoma of the cervix treated by total laparoscopic radical hysterectomy and pelvic lymphadenectomy is reported. To our knowledge, a total laparoscopic radical hysterectomy with laparoscopic lymphadenectomy has not been previously described in Italy.

Radiofrequency bipolar coagulation for radical hysterectomy: technique, feasibility and complications.

This study describes the surgical technique and intra- and postoperative complications associated with the use of a radiofrequency bipolar coagulator in a series of 18 Piver type III-IV radical hysterectomies performed in cervical cancer patients. Preliminary vessel-by-vessel dissection of the lateral parametria was possible in 17 out of 18 (94%) cases, and a direct application of a radiofrequency bipolar coagulation instrument was performed to coagulate the posterior and anterior parametrial tissues in all cases. We were able to easily coagulate isolated vessels up to 5 mm of maximal diameter. In no case were clamps or hemoclips necessary to complete hemostasis. We did not observe any parametrial vessel damage or heat-related injury of the surrounding normal tissue. The median size of the parametria removed was 44 mm (range 31-58) and nodes were detected in 15 cases (83%). Median operative time and estimated blood loss for the whole procedure including systematic pelvic and aortic lymphadenectomy was 250 min (range 200-410) and 550 ml (range 400-2500), respectively. Median follow-up time was 9 months (range 5-13). No complications specifically related to the use of radiofrequency coagulation were found. In conclusion the radio-frequency coagulation with this instrument appears to be a safe technique that is particularly useful in reducing blood loss and operative time without affecting radicality in patients undergoing radical hysterectomy.

[Videolaparoscopic appendectomy with linear stapler]. / Apendicectomia videolaparoscópica com auxílio de grampeador linear cortante.

It is presented the experience of 126 cases of acute appendicitis treated by a videolaparoscopic appendectomy using a 12 mm endostapler with 4 lines of staples and a linear cutting device in the middle. It has been used two trocars (5 mm) at the left side and one other (12 mm) trocar at the umbilicus. In the first cases other dispositions were used but this one seemed to be better. Through the left trocars, a dissection is promoted, isolating the appendix, its base and its mesentery, in which a small hole is made, close to the base. Through this hole, it is passed one of the sides of the 12 mm stapler. The device promotes the bilateral stapling and cuts the appendix at its base. The stapler is reloaded with vascular staples and then the mesentery is stapled and cut by the same way. It is a very fast method. Besides, the laparoscopic option gives the opportunity to equally treat appendicitis at unusual positions, to examine other pelvic organs (eventually treating diseases) and to aspirate secretions under direct view, anywhere in the cavity. The specimen is taken out of the cavity inside a plastic bag and we had no case of infection at the trocar sites. Only in 3 cases there were conversion to open surgery, due to difficult dissection and identification of structures, in all of them with very advanced disease and necrosis. It is concluded that this method is fast, safe, easy (although more expensive) and can be utilized routinely, at least in the first approach of the treatment of acute appendicitis.

[Surgical therapy in high-risk patients with endometrial adenocarcinoma]. / Terapia chirurgica in pazienti ad alto rischio affette da adenocarcinoma dell'endometrio.

Personal experience with 100 cases of endometrial adenocarcinoma surgically treated in 1983-87 revealed a significant link between grading, myometrial infiltration and lymph node involvement. This finding forms the basis for the creation of a special classification system used in selecting the therapeutic approach, the aim being to avoid radical surgery in those patients considered "high risk" due to their poor cardiovascular or metabolic condition or obesity, while ensuring that the appropriate treatment is given.

[Cancer of the cervix uteri in pregnancy: surgical treatment with conservation of the ovaries. Clinical case]. / Cancro del collo dell'utero in gravidanza: trattamento chirurgico con conservazione delle ovaie. Caso clinico.

Authors report the case of 32 years old pregnant woman, who at the VI month of pregnancy developed an invasive carcinoma of the cervix uteri. It is hypothesized that surgical therapy according to Weirtheim-Meigs, without bilateral ovariectomy, consent the conservation of the reproductive function in the young women thought the development of the artificial insemination technics.