The BiClamp procedure proved superior or similar to conventional ligation, particularly with regard to intraoperative blood loss, operating time and postoperative pain, although statistical significance was not attained for postoperative pain. Moreover, BVS was easier to use and more cost effective.
Background. LACC trial demonstrated inferiority of laparoscopic approach for the treatment of early-stage cervical cancer. There are still limited data from retrospective trials regarding whether survival outcomes after laparoscopic radical hysterectomy are equivalent to those after open abdominal radical hysterectomy. In this study, we present results of combined vaginal radical laparoscopic hysterectomy in the treatment of early-stage cervical cancer. Methods. This retrospective study was carried out at the Department of Gynecology in Mathilden Hospital (Herford, Germany). Between January 2008 and April 2018, all the patients with invasive cervical cancer who underwent combined vaginal assisted radical laparoscopic hysterectomy (VARLH) without the use of any uterine manipulator were enrolled to the study. Results. A total number of 124 patients with diagnosis of invasive cervical cancer were enrolled in the study. All of the patients underwent minimally invasive surgery and were divided according to FIGO 2019: stage IA (25.9%), IB1 (25.0%), IB2-IIB (28.4%), and III/IV (20.7%). Overall, the mean age of the patients was 51.84 years. After a study collection, a median follow-up was 45.6 (range 23.7-76.5) months. The 3- and 5-year disease-free survival rates for early-stage cervical cancer were both 98%, and the 3- and 5-year overall survival rates were 100% and 97%, respectively. We have not observed any recurrence in our study group of patients with early-stage cervical cancer. Conclusions. Combined VARLH can be considered a safe and effective procedure for the treatment of early-stage cervical cancer. Surgical strategy with oncological principles determines the quality and long-term success of the operation in early cervical cancer regardless of laparoscopic approach.
ZusammenfassungDas disseminierte intraperitoneale Leiomyom (LPD) ist eine seltene Erkrankung, in der Literatur sind knapp 50 Fälle weltweit beschrieben. Wir berichten über eine 48-jährige weiße Patientin, welche sich mit Unterbauchschmerzen in unserer Klinik vorstellte. In der Ultraschalluntersuchung ließen sich trotz eingeschränkter Möglichkeiten bei einem BMI von > 30 bis zu 15 Tumoren im Unterbauch nachweisen sowie ein Aszites. Die Patientin war sechs Jahre zuvor hysterektomiert worden. Die Patientin hatte anamnestisch noch nie Kontrazeptiva eingenommen. Wäh-rend der Operation wurde durch eine Schnellschnittuntersuchung ein LPD diagnostiziert. Es erfolgten die Adnexektomie beidseits, die großflächige Adhäsiolyse, sowie eine Resektion des Omentum majus mit bis zu 2 kg Myomen. Die Aszitesuntersuchung ergab das Bild eines Reizergusses. Die Prognose des LPD ist sehr gut. Im Fall der Patientin ließ sich eine Proliferationsaktivität (Ki 67) von unter 1 % nachweisen. Bei Östrogen-/Progesteronrezeptorpositivität ist eine Therapie mit GnRh-Analoga mög-lich. Bei der Patientin des Fallberichtes schloss sich postoperativ keine Therapie an.
SchlüsselwörterDisseminiertes intraperitoneales Leiomyom · multiple Myome · gutartige intraperitoneale Muskelknoten · LPD
AbstractWe report on a case of disseminated peritoneal leiomyomatosis (LPD). Disseminated peritoneal fibroids are a very rare medical condition, only up to 50 cases can be found in the international literature. Our patient, a 48-year-old caucasian woman, complained of right sided pelvic pain. Her medical history included vaginal hysterectomy for dysmenorrhea six years before. She had a BMI of 30 and had never used hormonal contraceptives. Sonography revealed multiple small tumors in the pelvis and some free fluid in the abdominal cavity. CA 125 was elevated, which led to the presumptive diagnosis of ovarian cancer. Intraoperatively, we found disseminated leiomyomas in the ovaries, greater omentum and the peritoneum which were resected. Histopathologic workup showed that the grade of proliferation of the fibroids was less than 1 %. As this rare disease has a good prognosis without further treatment, no postoperative therapy was planned.
Key wordsDisseminated peritoneal leiomyoma · multiple myoma · benign intraperitoneal muscle nodules · LPD Fallbericht 1074 Institutsangaben Zentrum für Frauenheilkunde, Städt. Kliniken Bielefeld Mitte Korrespondenzadresse Dr. med. Dipl. oec. med. Rüdiger Langenberg · Frauenklinik · Stiftungskrankenhaus Bethanien für die Grafschaft Moers · Bethanienstraße 21 · 47441 Moers ·
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