Long-term follow-up and quality of life after robot assisted sacrohysteropexy.

OBJECTIVE: The aim of this study is to investigate the effect of robot assisted laparoscopic sacrohysteropexy (RALS), with preservation of the uterus, in patients with pelvic organ prolapse on short and long term outcome. We report on (anatomical) status of the prolaps and the associated health related quality of life of women treated with RALS before and five years after surgery. STUDY DESIGN: A prospective cohort study in a teaching hospital in The Netherlands was performed. Quality of life was assessed pre-operative, post-operative and five years after RALS using the UDI/IIQ validated self-questionnaire designed for Dutch-speaking patients. Clinical and operative data were prospectively collected up to five years. Statistical analysis of categorical data was performed with the paired T-test. Descriptive statistics were computed with the use of standard methods for means, median and proportions. RESULTS: Hundred women with utero vaginal prolapse were treated with RALS with preservation of the uterus. The overall success rate of pelvic organ prolapse (POP) was 89.2%. After surgery the quality of life improved (P<0.05) Overall health status, based on a 0-100% visual analogue scale (VAS), improved from 72.6% pre-operative to 82.2% six weeks postoperative (P<0.05). Postoperative patients experienced less feelings of nervousness (P=0.01), shame (P<0.05) and frustration (P<0.05). The positive effects on these feelings remained present after five years. The learning curve shows a decrease in operating time with gained experience. CONCLUSION: RALS has proven to be a safe and effective treatment for uterine preserving surgery in cases of pelvic organ prolapse. The long term anatomical outcomes and quality of life after RALS compare favorably with laparoscopic and open hysteropexy.

Sentinel node procedure in vulvar squamous cell carcinoma: a histomorphologic review of 32 cases. The significance of anucleate structures on immunohistochemistry.

The sentinel lymph node (SLN) procedure is used in our institute in the setting of an observational multicenter study investigating the reliability of the sentinel node procedure in vulvar carcinoma (GROINSS-V: The Groningen International Study on Sentinel Nodes in Vulvar Cancer). One of our patients had a groin recurrence where the SLN had been reported as negative. After reviewing this SLN, it contained several anucleate, keratin-positive structures on immunohistochemistry, and in the same area on hematoxylin and eosin coloring, one single cell with a nucleus interpreted as a tumor cell. Our objective was to assess how frequently these anucleate structures occur and whether such nodes should be regarded as positive. The sentinel nodes from 32 patients with early-stage vulvar squamous cell carcinoma were reviewed. Seventy-seven SLN's were identified. In ten patients, the SLN was positive and a bilateral inguinofemoral lymph node dissection was subsequently performed. In two of these ten patients, both with a macrometastasis on SLN, further metastatic disease was present in the dissection specimen. Anucleate keratin-positive structures were seen on immunohistochemistry in 14 SLN's (18%), usually along with metastasis or single tumor cells, but in five nodes this was the only abnormality (mean follow-up period of 26.28 months). Anucleate keratin-positive structures are a common finding in immunohistochemical examination of SLN's. Our findings suggest that they are of no clinical significance and the SLN should be regarded as negative. When an atypical cell with a nucleus is present, the SLN should be classified as positive and further management should be accordingly.