LESS with Suture Suspension for Early-Stage Adnexa Cancer Staging

• Published in: Journal of the Society of Laparoendoscopic Surgeons 2019-07, Vol.23 (3), p.e2019.00024
• Main Authors: Lin, Chen, Ying, Zheng, Xiao Rong, Qi, Sijing, Chen, Ling, Min, Xi Biao, Jia
• Format: Article
• Language: English
• Subjects: Endometrial Neoplasms - diagnosis; Endometrial Neoplasms - surgery; Female; Humans; Laparoscopy - methods; Middle Aged; Neoplasm Staging - methods; Operative Time; Suture Techniques - instrumentation; Sutures; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - surgery
• ISSN: 1086-8089; 1938-3797
• DOI: 10.4293/JSLS.2019.00024

Laparoendoscopic single-site surgery has been used in treating gynecologic diseases including early-stage cervical and endometrial cancer, but less so in early-stage adnexal cancer. We aimed to demonstrate the use of laparoendoscopic single-site surgery with suture suspension for staging of early-stage ovarian/fallopian-tube cancer and describe the study results. Seven patients with early-stage adnexal cancer underwent staging surgery via laparoendoscopic single-site surgery at West China Second University Hospital of Sichuan University from November 2017 to September 2018. All cases were successfully staged via this technique. Two patients underwent the high-level para-aortic lymphadenectomy up to the infrarenal vein, and four patients underwent para-aortic lymphadenectomy at the level of the inframesenteric artery; one patient underwent the para-aortic lymph node sampling. The operation time was 305-365 minutes. The estimated intraoperative blood loss was 50-200 mL. No intra-operative complications occurred; one patient developed pneumonia 48 hours postoperation. The number of pelvic and para-aortic nodes was 15-39 and 1-18, respectively. Pain scores 12 and 24 hours postsurgery were 2-3 and 1-2 with the use of butorphanol tartrate, respectively. On 4-14 months followup, the umbilical incision had good cosmesis; no umbilical hernia or vaginal dehiscence and no neoplasm recurrence were noted. Laparoendoscopic single-site surgery may be a feasible and safe technique for staging early-stage ovarian/tubal cancer. This approach has some advantages included providing easier access to the upper abdominal regions when performing high-level infrarenal para-aortic lymphadenectomy; the 2-cm elastic incision favors fast specimen extraction and colpotomy are avoided. However, the long-term oncologic outcomes need to be further investigated.