Cerrahi kongresi kongre biLİmsel programi ve biLDİRİ Özetleri

 www.minimalinvazivjinekolojikcerrahi.org
21 - 25 Şubat 2018
Wyndham Grand İstanbul Levent • İstanbul
MİNİMAL İNVAZİV JİNEKOLOJİK
CERRAHİ KONGRESİ
V-39 
Robotic Sentinel Lymph Node Mapping for Early Stage Endometrial Cancer
Fatema Adel Alkhan
1
, Emine Karabuk
1
, Mehmet Murat Naki
1
, Mete Gungor
2
, Mehmet Faruk Kose
1
1
Acibadem University Atakent Hospital, Istanbul, Turkey
2
Acibadem Maslak Hospital, Istanbul, Turkey
OBJECTIVE: To demonstrate step-by-step sentinel lymph node dissection in early staged 
endometrial cancer, followed by complete pelvic lymph node dissection
 
METHOD: A 64-year-old lady presented with history of postmenopausal bleeding to our center. 
Endometrial biopsy was taken and showed endometrioid adenocarcinoma, Grade 1 according 
to FIGO classification. Therefore, patient was posted for robotic sentinel lymph node mapping 
and staging.
 
CONCLUSION: Sentinel lymph node mapping in early stage endometrial cancer with low grade 
risk has the potential to decrease the morbidity caused by complete pelvic lymph node dissection
 
Keywords: Robotic, Sentinenl, Cancer
 
 
 

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21 - 25 Şubat 2018
Wyndham Grand İstanbul Levent • İstanbul
MİNİMAL İNVAZİV JİNEKOLOJİK
CERRAHİ KONGRESİ
 www.minimalinvazivjinekolojikcerrahi.org
V-40 
Robotik cerrahi ile endometrium kanseri olgularında lenf nodu diseksiyonu
Orhan Ünal
1
, Osman Köse
2
, Mehmet Suhha Bostancı
2
, Nermin Akdemir
2
1
Yeditepe üniversitesi tıp fakültesi kadın hastalıkları ve doğum kliniği ana bilim dalı
2
Sakarya üniversitesi tıp fakültesi kadın hastalıkları ve doğum kliniği ana bilim dalı
Endometrium kanseri jinekolojik kanserler arasında en sık görülen kanserdir. 2017 yılında 
Amerika birleşik devletlerinde 61.380 yeni olgu ve 11.000 ölüm gerçekleşmiştir. Erken evre 
endometrium kanserinin standart tedavisi histerektomi ve bilateral salpingooferektomidir. 
The International Federation of Gynecology and Obstetrics (FIGO 1988) endometrium kanserli 
hastalar için cerrahi evreleme önermektedir. Endometrium kanserli hastalarda en önemli 
pronostik faktörlerden biri lenf nodu pozitifliğidir. Lenf nodu pozitifliği; tümörün histolojik 
tipi, tümörün çapı, myometrial invazyonu, grede 3 tümörler ve lenfovasküler invazyon varlıği 
etkilemektedir. Bizim kliniğimizde lenf nodu pozitifliğini etkileyebilecek kriterler dikkate 
alınarak lenf nodu diseksiyonu yapılmaktadır. Erken evre endometrium kanserlerinde diseksiyon 
kammon iliak arter seviyesine kadar yapılır. Lenf nod poztifliği öngeren kriterler dikkate alınarak 
yapılan çalışmalarda Tümör çapı <2 cm tümör lerde lenf nodu (LN) % 0 > 2 cm olan tümörlerde 
ise %22, myometrial invazyon < %50 ve < 2cm tümörlerde LN %1 >%50 invazyonda LN %9 dur. 
Erken evre endometriyal karsinom için histerektomi ve lenfadenektomide abdominal yaklaşıma 
karşı robotik cerrahi yaklaşım farrklı bir alternatiftir. Robotik cerrahi evreleme avantajları hasta 
ile ilgilidir. Karın kesiden kaçınıldığı için iyileşme daha hızlı gerçekleşmektedir. Robotik cerrahide 
pelvik lenf nodu diseksiyonu, uygulanabilir bir prosedürdür.
 
Anahtar Kelimeler: robotik cerrahi, endometrium kanseri, lenf nodu
 
 
 

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 www.minimalinvazivjinekolojikcerrahi.org
21 - 25 Şubat 2018
Wyndham Grand İstanbul Levent • İstanbul
MİNİMAL İNVAZİV JİNEKOLOJİK
CERRAHİ KONGRESİ
V-41 
Robotic pelvic side-wall dissection prior to radical pelvic surgery
Tayfun Toptas
1
, Isin Ureyen
1
, Aysel Uysal
2
1
Department of Gynecologic Oncology, SBU Antalya Research and Training Hospital, Antalya, 
Turkey
2
Department of Gynecologic Surgery, SBU Antalya Research and Training Hospital, Antalya, 
Turkey
OBJECTIVE: Most conventional gynecologic surgeries can be performed without a detailed 
knowledge of pelvic side-wall anatomy as few of them require tissue dissection to identify 
retroperitoneal structures. Many general gynecologists have, therefore, been reluctant to learn 
pelvic side-wall dissection techniques that involve what seems to them extensive and unnecessary. 
However, a well prepared and dissected pelvic side-wall is a sine qua non for the complete surgical 
resection of gynecologic cancers as well as of the benign diseases extending to this area. In this 
presentation, we sought to show a brief video demonstration of robotic technique for the dissection 
of pelvic side-wall prior to systematic lymphadenectomy in a patient with endometrial cancer. 
Surgical technique: The surgery was performed using daVinci® XI robotic system with four 
arms. First, the peritoneum was opened one cm parallel and lateral to the gonadal vessels and 
adnexae, from the round ligament distally to the caecum proximally. Following the opening of 
the avascular plane between the external iliac vessels and obliterated umbilical artery by blunt 
and sharp dissection, the lateral paravesical space (obturatory) was developed. Dissection was 
continued cranially to the iliac bifurcation; the hypogastric artery and its main medial branch 
(uterine artery) were identified respectively.Then, the ureter was adequately freed from the 
surrounding mesenchimal tissue from the level of common iliac artery up to the anterior 
parametria (ureteric tunnel). Afterwards, the lateral pararectal space, which is bordered laterally 
by hypogastric artery, caudally by uterine artery, medially by ureter and cranially by sacrum, was 
developed. Finally, the uterine artery was ligated and cut at the level of hypogastric artery.
 
CONCLUSION: A meticulous dissection and taking care of the anatomical landmarks are the keys 
of a safe and bloodless pelvic side-wall dissection prior to radical pelvic resection.
 
Keywords: Robotic surgery, pelvic side-wall, surgical dissection

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