Laparoscopic lymphadenectomy for gynecologic malignancies using ultrasonically activated shears: analysis of first 100 cases.
OBJECTIVE
To evaluate the feasibility, safety and utility of the ultrasonic shears for laparoscopic pelvic and para-aortic lymph node retrieval in the treatment of gynecologic cancers.


METHODS
Data on laparoscopic lymphadenectomy performed for gynecologic malignancies using ultrasonic shears over a 5-year period were collected and analyzed prospectively.


RESULTS
Laparoscopic lymphadenectomy using ultrasonic shears was performed on 100 patients with a median age of 58 (17-87) years. The types of malignancies included cervical (n = 29), endometrial (n = 48), ovarian (n = 15), fallopian tube (n = 2), malignant mixed mesodermal tumor (n = 2), vaginal (n = 2) and synchronous ovarian and endometrial cancers (n = 2). Sites of lymphadenectomy included pelvic (n = 49), para-aortic (n = 30) or both pelvic and para-aortic (n = 21). The median nodal yield was 22 (0-87). 66/100 were complete lymphadenectomies with a median nodal yield of 28 (2-71). The median length of hospital stay was 2 (1-13) days and the average blood loss was 148 (0-500) ml. Overall complication rate was 13%. There were 3 intra-operative complications, which were all managed laparoscopically. There were no unplanned conversions to laparotomy. There were 10 post-operative complications including port-site metastasis in a patient with positive nodes (n = 1), trocar-site hernia requiring a second laparoscopy (n = 1), deep leg vein thrombosis (n = 1), and a small bowel obstruction (n = 1).


CONCLUSIONS
This is the largest series to date demonstrating the safety and efficacy of ultrasonic shears in laparoscopic lymphadenectomy for gynecologic malignancies. In addition to the potential for lowering the risk for tissue damage, ultrasonic shears offer multifunctionality which allows for a simpler technique with the use of fewer instruments.
Nezhat
Farr
F
Division of Gynecologic Oncology, Department of Obstetric, Gynecology and Reproductive Sciences, The Mount Sinai Hospital, 1176 Fifth Avenue, Box 1173, New York, NY 10029, USA. Farr.nezhat@mssm.edu
Yadav
Jyoti
J
Rahaman
Jamal
J
Gretz
Herbert
H
Gardner
Ginger J
GJ
Cohen
Carmel J
CJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005833:Genital Neoplasms, Female / Q000000981:diagnostic imaging* / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008197:Lymph Node Excision / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000601:surgery*; D008875:Middle Aged; D011446:Prospective Studies; D013525:Surgical Instruments; D014464:Ultrasonic Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D014463:Ultrasonography