open surgery is usually performed if the size is large. The authors want to show that successful resection can be achieved using the laparoscopic approach. Description In this surgical method, before entering the abdominal cavity completely, only the peritoneum was left. The space was expanded to approach the retroperitoneal space. 4 ports were used, and advanced bipolar, articulating forceps and metal clips were used. The metastatic lymph node was present on the left side and was approached from the left side, and the area where the ureter enters the kidney did not expand. The root of the metastatic lymph node was in the space between the posterior renal vein and the anterior renal artery. After blunt dissection was performed around it, the root was ligated with a metal clip. Conclusion/Implications When operating ovarian cancer, opensurgery is performed if it is not in the early stage. Also, when lymph node dissection is performed, a ventral approach is used, and the bowel is lifted at this time, which may cause postoperative pain and complications.However, if the retroperitoneal approach (side or dorsal) is performed, a sufficient field of view can be secured without directly touching the bowel, and the length of the incision can be shortened, thereby reducing complications after surgery.This surgical approach is considered to be a method that should be considered if it is any indication.
Description We use blue cap, hegar(13) for immobilizing uterine cervix. We use multi-articulating instrument, artisential, to move tissue in single site robotic surgery by Davinci Xi, and single port robotic surgery by Davinci SP. In both robot surgery, artisential is useful instrument to perform PLND hysterectomy without uterine manipulator. Conclusion/Implications Using multi-articulating instrument is reasonable option to perform PLND hysterectomy without uterine manipulator by counteraction done.
Methods Patients with histologically confirmed H-SIL and/or VIN 2-3 will be treated with Pembrolizumab 200 mg flat dose every 3 weeks for 5 cycles. Within 4 weeks from the last Pembrolizumab administration patients will be submitted to surgical conization (either cold knife conization or LEEP) and/or partial or radical vulvectomy. During the screening phase patients will receive blood and stool specimen's collection. Genotyping for HPV will be performed at baseline, surgery and at safety follow up visit. Results Trial in progress: there are no available results at the time of submission.
Our curative RT eligibility criteria were TNM Stage T 3, N 1; AJCC Stage IIB to IIIC; and undergoing lumpectomy. This study received domestic and international Institutional Review Board approval. Results We reviewed 441 patient records. The mean age was 53.0 years and 56.0% of patients presented with Stage IIIA-C breast cancer. The median distance traveled for RT was 155 km (range = 3.3-1082 km). We had surgery data on 313 patients (71%) with 41.0% of patients undergoing mastectomies and 11.3% undergoing lumpectomies. Most patients presented with a Karnofsky Performance Status of 90-100 (84.1%). The majority of patients were eligible for curative RT (340; 77.1%), however, only 150 (44.1%) went on to initiate radiation treatment. The median dose received was 4500 cGy and the median boost dose was 900 cGy. Univariate logistic regression analysis revealed the following variables as significantly associated with initiating RT: Mastectomy (p<0.001) and Karnofsky Performance Status >90 (p = 0.04). Conclusions This study identified a sizable gap in RT uptake among patients with breast cancer in Botswana, with only 44.1% of eligible patients initiating treatment. Since radiation therapy is covered by the government, it is imperative to consider other factors that could contribute to the lack of treatment initiation, including health literacy and RT schedules with downtime.
Description A 34-year-old IB1 FIGO stage squamous cell cervical cancer underwent a combined robotic laparoscopic-vaginal radical trachelectomy with enclosed colpotomy and without manipulator. After spontaneous pregnancy, she underwent a laparoscopic free needle cerclage. The pregnancy progressed with preterm amniotic membranes rupture and fetal loss at 19 weeks. Another spontaneous pregnancy occurred and an elective abdominal cerclage with Mersilene double suture by robotic-assisted laparoscopic technique was done. Ultrasonographically, the internal os, the endocervix, and the gestational sac were maintained under visualization throughout the procedure. At the same time, two robotic needle holders drove two needles symmetrically, passing from the posterior to the anterior portion of the cervical isthmus junction perpendicularly to the uterine axis and a blockage suture sequencing knots were made on the remaining cervix. Another identical suture was performed caudally. At 31 weeks, asymptomatic premature cervical dilatation was noted, and the patient was hospitalized. C-section was performed at 33 weeks and two days, and a healthy male infant was born. Conclusion/ImplicationsThe cervix is a fundamental structure for the development and the maintenance of a pregnancy. Different from patients with cervical incompetence, where there is data sustaining cervix cerclage, the literature is poor on the maintenance of pregnancy in post trachelectomy patients. This was a case report of a favorable evolution of pregnancy after cerclage in a patient with surgical removal of the cervix as cancer treatment.
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