Total Laparoscopic Nerve-Sparing Radical Hysterectomy Using the No-look No-touch Technique.

IF 0.8 Q4 SURGERY
Surgery Journal Pub Date : 2021-10-12 eCollection Date: 2021-12-01 DOI:10.1055/s-0041-1736178
Atsushi Fusegi, Hiroyuki Kanao
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引用次数: 1

Abstract

Radical hysterectomy is a standard operation for patients with early-stage cervical cancer. Over the recent decades, laparoscopic radical hysterectomy has been considered an alternative treatment. In 2018, the results of the laparoscopic approach to cervical cancer trial suggested that women with early-stage cervical cancer who underwent minimally invasive surgery for radical hysterectomy had poorer prognosis than those who underwent open surgery. This finding was unexpected, and direct evidence supporting poor prognosis related to minimally invasive radical hysterectomy was not available because the trial was not designed to evaluate the cause of the inferior outcomes. Tumor spillage caused by surgeon-related factors, including squeezing of the uterine cervix and tumor exposure to circulating CO 2 gas, is considered to be associated with the poor prognosis of patients who underwent minimally invasive radical hysterectomy. We believe that protective maneuver to avoid tumor spillage is the key to improve oncologic outcomes of cervical cancer. Here, we present a procedure of total laparoscopic nerve-sparing radical hysterectomy for early-stage cervical cancer in which techniques, such as the "no-look no-touch technique," were used to prevent tumor spillage.

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全腹腔镜保留神经根治性子宫切除术——应用“不看不摸”技术。
根治性子宫切除术是早期宫颈癌患者的标准手术。近几十年来,腹腔镜根治性子宫切除术被认为是另一种治疗方法。2018年,腹腔镜下宫颈癌临床试验结果显示,早期宫颈癌患者行微创根治性子宫切除术的预后比开放手术差。这一发现是出乎意料的,并且没有直接证据支持与微创根治性子宫切除术相关的不良预后,因为该试验不是设计来评估不良结果的原因。手术相关因素引起的肿瘤溢漏,包括宫颈挤压和肿瘤暴露于循环CO 2气体中,被认为与微创根治性子宫切除术患者预后不良有关。我们认为避免肿瘤外溢的保护性操作是改善宫颈癌肿瘤预后的关键。在这里,我们提出了一种全腹腔镜保留神经的根治性子宫切除术治疗早期宫颈癌,其中使用了诸如“不看不接触技术”等技术来防止肿瘤扩散。
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来源期刊
Surgery Journal
Surgery Journal SURGERY-
自引率
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发文量
64
审稿时长
12 weeks
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