Laterally-Extended Endopelvic Resection (LEER) of recurrent epithelioid trophoblastic tumor by laparoscopy

We report the resection of a recurrent epithelioid trophoblastic tumor by laparoscopic Laterally-Extended Endopelvic Resection (LEER). The LEER technique was developed to resect en bloc multiple visceral compartments involving the lateral pelvic wall with negative margins for local control of advanced and recurrent malignancies. Described by Höckel, this procedure is usually performed by a midline laparotomy.Our patient had undergone prior laparotomic surgery including hysterectomy, partial bladder resection and a right ureteral re-implantation for an epithelioid trophoblastic tumor without adjuvant treatment. She presented a recurrent tumor infiltrating the bladder, the ureter and the right pelvic wall as well as internal and external iliac vessels.A vascular surgeon first performed a femoro-femoral bypass by bilateral groin incisions with subcutaneous tunnel. The surgery was then exclusively performed by laparoscopy using the LEER technique including resection of both external and internal iliac vessels, the pelvic wall through the lateral pelvic muscles, and iterative bladder resection associated with a ureteral re-implantation using the psoas hitch bladder technique. The patient experienced Clavien-Dindo classification grade II postoperative complications. Histology showed a margin-free resection (R0).
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research

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We report our experience on nine cases that were completed prior to our French UTx robot-assisted trial.
Source: Journal of Robotic Surgery - Category: Surgery Source Type: research
The objectives of our study were to (1) examine the rate of vesicoureteral injury on benign hysterectomy by the surgical approach and (2) compare the risk of vesicoureteral injury specifically between minimally invasive laparoscopic and abdominal hysterectomy on a populational level.DesignRetrospective population-based observational study.SettingThe National Inpatient Sample.PatientsA total of 501 110 women who had undergone hysterectomy for benign gynecologic disease between January 2012 and September 2015 were included as follows: total abdominal hysterectomy (TAH, n = 284 365 [56.7%]), total laparos...
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research
The objectives of our study were to (i) examine the rate of vesico-ureteral injury at benign hysterectomy by surgical approach and (ii) compare the risk of vesico-ureteral injury specifically between minimally-invasive laparoscopic and abdominal hysterectomy on a populational level.DesignRetrospective population-based observational study.SettingThe National Inpatient Sample.Patients501,110 women who underwent hysterectomy for benign gynecological disease from 1/2012-9/2015 were included: total abdominal hysterectomy (TAH, n=284,365 [56.7%]), total laparoscopic hysterectomy (TLH, n=60,410, [12.1%]), abdominal supracerv...
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research
We examined the impact of surgical approach (minimally-invasive laparoscopy versus laparotomy) on vesico-ureteral injury during inpatient hysterectomy for benign gynecological disease.
Source: The Journal of Minimally Invasive Gynecology - Category: OBGYN Authors: Tags: Open Communications 14: Laparoscopy (4:10 PM – 5:15 PM) 4:38 PM Source Type: research
We report the resection of a recurrent epithelioid trophoblastic tumor by laparoscopic laterally extended endopelvic resection (LEER). The LEER technique was developed to resect en bloc multiple visceral compartments involving the lateral pelvic wall with negative margins for local control of advanced and recurrent malignancies. Described by Höckel, this procedure is usually performed by a midline laparotomy. Our patient had undergone prior laparotomic surgery including hysterectomy, partial bladder resection, and a right ureteral reimplantation for an epithelioid trophoblastic tumor without adjuvant treatment. She pr...
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research
We report the resection of a recurrent epithelioid trophoblastic tumor by laparoscopic laterally extended endopelvic resection (LEER). The LEER technique was developed to resect en bloc multiple visceral compartments involving the lateral pelvic wall with negative margins for local control of advanced and recurrent malignancies. Described by H öckel, this procedure is usually performed by a midline laparotomy. Our patient had undergone prior laparotomic surgery including hysterectomy, partial bladder resection, and a right ureteral reimplantation for an epithelioid trophoblastic tumor without adjuvant treatment.
Source: The Journal of Minimally Invasive Gynecology - Category: OBGYN Authors: Tags: Instruments and Techniques Source Type: research
Abstract AimPatients who have undergone a cesarean section (CS) prior to hysterectomy are at a higher perioperative risk of complications. The purpose of this study was to evaluate the safety of total laparoscopic hysterectomy (TLH) in patients with prior CS. MethodsWe enrolled 482 patients treated with TLH. Surgical outcomes including major complications were compared between patients without prior CS (no CS group; n = 324) and patients with prior CS (prior CS group; n = 158). Major complications included vaginal cuff dehiscence, and bowel, bladder, ureter and great vessel injuries. ResultsMajor complications, uterus weig...
Source: Journal of Obstetrics and Gynaecology Research - Category: OBGYN Authors: Tags: Original Article Source Type: research
Conclusions When C-LH cannot be performed because of large uterine fibroids that cause poor visibility and/or mobility, LH+LM may allow the procedure to be successfully completed without conversion to laparotomy. However, the latter approach increases the risk for intraoperative blood loss.
Source: European Journal of Obstetrics and Gynecology and Reproductive Biology - Category: OBGYN Source Type: research
ConclusionsRobot-assisted extravesical VVF repair avoids the morbidity of a laparotomy, provides excellent exposure, and avoids a large cystotomy. It maintains vaginal length and allows for significantly better visualization compared with the transvaginal approach. This repair offers improved outcomes for certain patients depending on their history, anatomy, and the surgeon ’s experience.
Source: International Urogynecology Journal and Pelvic Floor Dysfunction - Category: OBGYN Source Type: research
Publication date: Available online 17 November 2016 Source:Journal of Minimally Invasive Gynecology Author(s): E.M. Sandberg, A.R.H. Twijnstra, S.R.C. Driessen, F.W. Jansen Hysterectomies performed laparoscopically have greatly increased within the last few decades and even exceed the number of vaginal hysterectomies (VH). This systematic review compares surgical outcomes of total laparoscopic hysterectomy (TLH) and VH to evaluate which approach offers the most benefits and was conducted according to the Meta-analysis of Observational Studies in Epidemiology guidelines. A literature search was performed in PubMed, Embase,...
Source: Journal of Minimally Invasive Gynecology - Category: OBGYN Source Type: research
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