Huicheng Xu

Laparoscopic nerve-sparing radical hysterectomy with fascia space dissection technique for cervical cancer: Description of technique and outcomes

OBJECTIVES The objectives of this study were to describe our laparoscopic nerve-sparing radical hysterectomy (LNSRH) technique and to assess the feasibility and safety of the procedure, as well as its impact on voiding function. We introduce a fascia space dissection technique in order to preserve the pelvic splanchnic nerve, the hypogastric nerve and the bladder branch of the inferior hypogastric plexus under magnification (×10.5) during laparoscopic radical hysterectomy (LRH) with pelvic lymphadenectomy. METHODS From October 2006 to November 2009, 163 consecutive patients with cervical cancer underwent laparoscopic radical hysterectomy (LRH) and pelvic lymphadenectomy, with 82 women undergoing LNSRH with fascia space dissection technique (LNSRH group) and 81 undergoing LRH (LRH group). Data from 163 patients were prospectively collected and compared. Post-operative assessment of bladder function included the following: the time to recover the ability to void spontaneously and to achieve a post-void residual urine (PVR) volume of less than 50 ml, with urination function graded. RESULTS The laparoscopic nerve-sparing radical hysterectomy procedure was completed successfully and was conducted safely in all of the patients. There were no conversions to open surgery in the two groups. The median operative duration in the LNSRH and the LRH groups were 163.52±34.47 min and 132.13±31.42 min, respectively. Blood loss was 142.12±62.38 ml and 187.69±68.63 ml, respectively. The time taken to obtain a post-void residual urine volume of less than 50 ml after removal of the urethral catheter was 7.42±2.35 d (5-18 d) in LNSRH group and was 16.75±7.73 d (5-35 d) in LRH group (P<0.05). The bladder void function recovery to Grades 0-I was 76 (92.7%) for the LNSRH group and 59 (72.8%) for the LRH group. A mean follow-up of 22.3 (5-42) months was adhered to, and no patient had a recurrence or metastasis. CONCLUSIONS The technique described in this preliminary study appears to be safe, feasible, and easy in our population, with satisfactory recovery of voiding function.

Laparoscopic transient uterine artery occlusion and myomectomy for symptomatic uterine myoma

OBJECTIVE To compare clinical outcomes of laparoscopic transient uterine artery ligation plus myomectomy (LTUAL) to simple laparoscopic myomectomy (LM) for symptomatic myomas. DESIGN Comparative observational study. SETTING Medical centers. PATIENT(S) One hundred sixty-seven patients with symptomatic myomas. INTERVENTION(S) Eighty-four patients underwent LTUAL and LM; 83 patients underwent LM only. MAIN OUTCOME MEASURE(S) Operative time, blood loss, gonadal hormone level, uterine artery resistance index, menorrhea, pregnancy rate, and recurrence rate of myoma. RESULT(S) The intraoperative blood loss in the LTUAL group was lower than in the LM group. The menstrual blood volume (MBV) and the menstrual period of the LTUAO group was unchanged after operation relative to the prediseased volume. No significant difference was found in the resistance index of the uterine artery blood flow, the recurrence rate, and the fertility rate between the LTUAL and LM groups. CONCLUSION(S) LTUAL and LM are a promising surgical treatment for symptomatic uterine myoma and did not produce any appreciable adverse effect on fertility.

A systematic review and meta-analysis of conventional laparoscopic sacrocolpopexy versus robot-assisted laparoscopic sacrocolpopexy

Robot‐assisted laparoscopic sacrocolpopexy (RALSC) has spread rapidly without the availability of comprehensive and systematically recorded outcome data.

Prospective randomized comparison of laparoscopic peritoneal vaginoplasty with laparoscopic sigmoid vaginoplasty for treating congenital vaginal agenesis.

Introduction and hypothesisThe aim of this study was to compare the effectiveness and long-term anatomic and functional results of laparoscopic peritoneal vaginoplasty and laparoscopic sigmoid vaginoplasty.MethodsFrom January 2002 to December 2010, 40 patients with congenital vaginal agenesis were prospectively randomized to undergo either laparoscopic peritoneal vaginoplasty (26 cases) or laparoscopic sigmoid vaginoplasty (14 cases) in 2:1 ratio. Pre- and postoperative examination findings, Female Sexual Function Index (FSFI) questionnaire responses, and sexual satisfaction rates are reported.ResultsAll surgical procedures were performed successfully, with no intraoperative complications. The laparoscopic peritoneal vaginoplasty group had significantly less blood loss and a surgery shorter on average than the laparoscopic sigmoid colovaginoplasty group. Postoperative course was uneventful for all patients in both groups, though postoperative retention time and hospital stay were less for peritoneal vaginoplasty patients than for sigmoid vaginoplasty patients. Mean neovaginal length, excessive mucous production, sexual life initiation time, and sexual satisfaction rate were similar between groups. Patient complaints of abdominal discomfort, unusual odor from vaginal secretions, and vaginal contraction during intercourse were higher in the sigmoid colovaginoplasty group (p < 0.005 vs. peritoneal vaginoplasty). Postoperative FSFI scores did not differ significantly between groups.ConclusionsRelative to laparoscopic sigmoid colovaginoplasty, laparoscopic peritoneal vaginoplasty provides good anatomic and functional results and excellent patient satisfaction.

Laparoscopic Resection of Presacral Teratomas

Presacral and retrorectal space tumors are relatively rare lesions, the location of which can result in the onset of symptoms that are not well-defined. Retrorectal teratomas are resected to alleviate these symptoms and to rule out malignancy. Complete resection by one of the open abdominal or sacral approaches was traditionally advocated as the best treatment for either a benign or malignant presacral and retrorectal tumor. A 15-year-old girl had chronic, progressively worsening dull pelvic pain and was given the diagnosis of a retrorectal tumor during her first gynecologic examination. Computed tomography of the pelvis showed an encapsulated presacral and retrorectal tumor measuring 10x8.5x8 cm. The retrorectal teratoma was removed by laparoscopy. No complication was observed interoperation. In addition, no sensory or motoric dysfunction of the bladder or rectum was observed postoperatively. Laparoscopy can be used to surgically remove presacral teratomas.

Laparoscopic blockage of uterine artery and myomectomy : A new method of treating symptomatic uterine leiomyomas

BackgroundThe goal of this study was to evaluate the effects of laparoscopic coagulation or blockage of the uterine arteries and myomectomy in treating symptomatic myomas.MethodsA total of 142 women with symptomatic fibroids warranting surgical treatment and wanting to retain their uteri were treated by laparoscopic coagulation or blocking of the uterine arteries and myomectomy.ResultsMost of the 142 patients had multi-myomas of the uterus, as intramural myomas (54), subserous myomas (65), and submucosal myomas (25). The number of myomas in each patient varied from 1 to 4. The size of the myomas in all patients ranged from 2 to 12 cm. In 86 cases (60.4%) the uterine wall was sutured in one layer. Average operating time was 124.2 ± 33.1 min, and average blood loss was 117.8 ± 48.6 ml. Mean postoperative hospital stay was 4.8 ± 1.2 days. All patients underwent technically successful laparoscopic coagulation or blocking of uterine arteries and myomectomy without intraoperative complications. The mean follow-up time was 16.2 months (16–26). Symptomatic improvement was achieved in all patients. Five patients experienced recurrence of myomas.ConclusionsLaparoscopic coagulation or block of the uterine arteries and myomectomy appears to be a safe, effective, and promising new method for treating symptomatic uterine myomas.

Evaluation of the biocompatibility and mechanical properties of xenogeneic (porcine) extracellular matrix (ECM) scaffold for pelvic reconstruction

Introduction and hypothesisXenogeneic (porcine) extracellular matrix (ECM) scaffolds have been suggested as ideal biomaterials for regeneration medicine; however, ECM prepared from different tissue sources has shown distinctive biological properties. Therefore, a comprehensive understanding of biological characteristics of different tissue-derived ECM is essential in the design of scaffolds for pelvic reconstruction.MethodsWe compared the biological properties of ECM derived from different tissue sources of Bama miniature pigs as a pelvic biological patch in terms of histological structure, water absorption ability, biodegradation ability, mechanical properties, antimicrobial activity, and biocompatibility in vitro.ResultsDifferent ECM scaffolds have distinct structural differences, and all have good biocompatibility, and UBM exhibited better water uptake ability (above 500%), anti-biodegradation ability, mechanical properties, antimicrobial activity, and stem cell attachment properties than other tissue-derived ECM.ConclusionsPorcine UBM might serve as an ideal pelvic biological patch.

Laparoscopic nerve-sparing radical parametrectomy for occult early-stage invasive cervical cancer after simple hysterectomy.

Objective To investigate the feasibility and surgical outcomes of laparoscopic nerve-sparing radical parametrectomy (LNSRP) and lymphadenectomy for treatment of occult early-stage invasive cervical cancer after simple hysterectomy. Methods From 2006 to 2010, 28 patients who were discovered to have occult early-stage invasive cervical cancer after a simple hysterectomy underwent LNSRP, upper vaginal resection, and pelvic lymphadenectomy. A retrospective analysis of these cases was performed. Results All patients underwent successful LNSRP. There was no conversion to laparotomy. The mean ± SD operation time was 173.30 ± 56.20 minutes. The mean ± SD estimated blood loss was 230.00 ± 109.55 mL. Two intraoperative complications were recorded. The median number of extracted pelvic and para-aortic lymph nodes was 23 (range, 12–36) and 7 (range, 3–15), respectively. The mean ± SD time before Foley catheter removal was 5.6 ± 2.74 days (range, 3–14 days ), and bladder voiding function recovery to grade 0 to grade 1 was observed in 26 patients (92.9%). Of the 28 patients, 3 patients received further adjuvant therapy. The median follow-up period was 38 (range, 4–62) months for all patients. No recurrence case was found in this series. Conclusion Laparoscopic nerve-sparing radical parametrectomy is a therapeutic option for occult early-stage invasive cervical cancer discovered after hysterectomy. Nerve-sparing radical surgery in indicated patients may lead to optimal preservation of bladder function.

Endoscopic inguinal lymphadenectomy with a novel abdominal approach to vulvar cancer: description of technique and surgical outcome.

STUDY OBJECTIVE To evaluate the feasibility and surgical outcome of a novel technique of endoscopic inguinal lymphadenectomy to treat vulvar cancer. DESIGN Retrospective analysis performed by a single center over 2 years (Canadian Task Force classification II-2). SETTING Major university teaching hospital. PATIENTS The medical records for 17 consecutive patients who underwent endoscopic inguinal lymphadenectomy because of invasive vulvar cancer were retrospectively reviewed. INTERVENTION Endoscopic inguinal lymphadenectomy was performed using a novel abdominal approach. MEASUREMENTS AND MAIN RESULTS All patients underwent abdominal endoscopic inguinal lymphadenectomy without intraoperative complications. Median (range) operative time for the endoscopic procedure was 94 minutes, with estimated blood loss of approximately 137 mL (80-170 mL). A mean (range) of 16 (11-23) nodes were retrieved. In an additional 5 patients, pelvic node dissection was performed, with retrieval of 6 (3-11) nodes. Of the 17 patients, 2 demonstrated vulvar wound necrosis, and 1 exhibited lymphorrhea through the drain orifice. No other inguinal wound-related complications were observed. Mean postoperative hospital stay was 11 (8-19) days. All patients were followed up for more than 13 months, with no recurrence of cancer. CONCLUSIONS Endoscopic inguinal lymph node dissection using this novel abdominal approach in patients with vulvar cancer is a safe and feasible technique that may diminish the wound-related complications associated with the standard open approach.

High levels of circulating CD34+/VEGFR3+ lymphatic/vascular endothelial progenitor cells is correlated with lymph node metastasis in patients with epithelial ovarian cancer.

Lymph node metastasis is one of the predictive factors associated with poor prognosis of epithelial ovarian cancer. To clarify the role of CD34 and vascular endothelial growth factor receptor‐3‐positive (CD34+/VEGFR3+) lymphatic/vascular endothelial progenitor cells (LVEPC) in patients with lymph node metastasis and epithelial ovarian cancer progression, the levels of circulating CD34+/VEGFR3+ LVEPC in epithelial ovarian cancer patients were detected. We also tested the plasma protein levels of VEGF and stromal cell‐derived factor to find out their possible relationships with lymph node metastasis in our epithelial ovarian cancer cohort.