J.M. Monaghan

home

authors

j-m-monaghan

Available       for download in Word Document format

Laparoscopic  hysterectomy was first described in 1989 (Reich) and rapidly thereafter  in 1991 laparoscopic pelvic lymphadenectomy was also described  (Querleu). During the 1990s the role of pelvic and latterly para aortic  lymphadenectomy has been extended and is now an integral part of best  practice Gynaecological Oncology Departments. Dargent has demonstrated  the role of both extra peritoneal and trans peritoneal dissection of the  pelvic and para aortic lymph nodes. All these authors have demonstrated  the feasibility of the technique and the ability to achieve high node  retrieval levels in their practice. The technique of pelvic  lymphadenectomy will be briefly demonstrated using a video from the  author’s department.

         Comparisons of laparoscopic versus open laparotomy  lymphadenectomy have not been formally made excepting using simple  criteria such as nodal counts. We are now in a situation where the  techniques have been used for a period of time which allows survival  data to begin to accrue. 

         In the author’s department over a 25 year period over one  thousand open radical hysterectomies and node dissections have been  performed and latterly some forty Coelio Schauta procedures with  lymphadenectomy for cancer of the cervix. Plus laparoscopically assisted  vaginal hysterectomy and lymphadenectomy for corpus cancer. The  feasibility and applicability of these techniques have been well  demonstrated. The author will discuss node retrieval, complications and  early survival data for patients who have had laparoscopic  lymphadenectomy performed for cancer of the body of the uterus and for  cancer of the cervix.

         It is now becoming clear that as the learning curve develops the  commonly held belief that laparoscopic surgery is extraordinarily slow  compared with open surgery is being refuted. In the author’s series the  performance of a laparoscopic pelvic lymphadenectomy + Schauta procedure  is now only very slightly longer than the open standard Wertheim Meigs  hysterectomy. Node retrievals are equivalent, recovery from the  procedure is very much faster for the laparoscopic patients and so far  survival data appears to be equivalent.

Articles

Laparoscopic hysterectomy was first described in 1989 (Reich) and rapidly thereafter in 1991 laparoscopic pelvic lymphadenectomy was also described (Querleu). During the 1990s the role of pelvic and latterly para aortic lymphadenectomy has been extended and is now an integral part of best practice Gynaecological Oncology Departments.

Author | J.M. Monaghan

Articles

The First World Congress On: Controversies in Obstetrics, Gynecology & Infertility