Incidental Fallopian Tube Adenocarcinoma Managed using Robotic Staging Surgery

Abstract

IntroductionPrimary fallopian tube tumors, which are rare gynecological malignancies that account for 0.14%-1.8% of genital malignancy, mainly affect women aged 40-65 years [1]. Diagnosing primary fallopian tube tumors is challenging, and case reports involving tumors managed using robot-assisted staging surgery are rare. However, we have reported here two cases with favourable prognoses of primary fallopian tube tumors managed using robot-assisted staging surgery. The robotic-assisted procedures using three robotic arms were performed with the patient in the lithotomy position under general anesthesia. A uterine manipulator was put in place, and a pneumoperitoneum was obtained. For setting of the robotic surgery, a 12 mm camera port was set 6 cm above the umbilicus, and 8 mm trocars were set 8 to 10 cm caudal-lateral to the scope for the side arms at each side of the patient, respectively. We placed a fenestrated bipolar forcep in left arm for electrocoagulation and a monopolar curved scissor in right arm for simultaneous cutting and electro-cauterization. A manually operated accessory trocar, which was set at 6 to 8 cm caudal-lateral to the left arm, was placed for lymph node extraction.The robotic arms were docked smoothly, and ascites was collected for cytological examination. The robotic surgery was performed with Endo Wrist instruments including monopolar curved scissors and fenestrated bipolar forceps. A grasper was used via the accessory port to assist in the surgical procedures. A survey of the operative field and evaluation of pelvic adhesion were performed. A frozen section of the suspected primary lesion was sent to confirm its malignancy prior to the main procedure. Surgical staging procedures including a total hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic retroperitoneal lymph node dissection, para-aortic lymph node dissection, appendectomy, omentectomy, peritoneal biopsies, and ascites cytology were performed. After the main procedures, the uterus was removed intact via the vagina, and transvaginal suturing was performed subsequently to close the vaginal cuff. After surgery, the dissected tissue was subjected to pathological examination. Case 1A 49-year-old woman visited the author's clinic for abnormal vaginal discharge. She had not had a previous surgery or any family history of ovarian malignancy. She had menarche at the age of 13 and has had a regular menstrual cycle since then. She had given birth to two children and had never had an abortion. A transvaginal ultrasound preformed in the clinic revealed ascites and a left adnexal heteroechoic mass, 7 × 3 cm. A P ap smear report revealed atypical glandular cells. On admission to the obstetrics and gynecology ward, an abdominal examination did not reveal anything significant; no abdominal palpable mass, abdominal pain or enlargement of lymph nodes were noted. A vaginal examination presented a free range of motion for the cervix with serosanguinous vaginal discharge but without palpable adnexal mass lesions. A pelvic CT scan show...