[Robot-assisted laparoscopy in the management of recurrent XXXX ].

@entity1 @entity5 @entity190 @entity957 @entity73 @entity2622 @entity260 @entity1151
OBJECTIVES: The aim of this study is to establish the feasibility of the management of recurrent @entity5 by robot-assisted laparoscopy, and particularly the feasibility of robot-assisted laparoscopy anterior pelvic exenteration, from a single center series of seven @entity1 . @entity1 AND METHODS: From February 2007 to April 2010, all @entity1 cared for recurrent @entity5 have been included (n=7). Five @entity1 have been cared for a cervical @entity5 , one @entity1 for recurrent VAIN 3, and one @entity1 for @entity957 of the vaginal vault after hysterectomy for @entity2622 in situ. All @entity1 were benefited from robot-assisted laparoscopy: two had surgery such as anterior pelvic exenteration with Miami Pouch urinary reconstruction, and five had colpectomy with or without lymph node removal, including one with vaginal preparation first before vaginal cuff resection. Data were collected prospectively identifying treatment history, intraoperative data, immediate outcomes, pathological findings, and long-term outcomes. RESULTS: From February 2007 to April 2010, 195 @entity1 underwent robot-assisted laparoscopy at the Institut Paoli-Calmettes. Among them, seven @entity1 had pelvic @entity5 . The median age was 53 years (44 to 67). The median BMI was 25 (19.7 to 35.3). The median Karnofsky index was 100 (80-100). The median operative time was 210 min (90 to 300) for colpectomy, 480 min for pelvectomy, 240 min (90-480) for the serie. The mean duration of the installation of the robot, all procedures combined, is estimated at 22.5 min (  4.8 min). There was no conversion to laparotomy, the median @entity190 was 340 ml (100 to 800). One @entity1 was transfused with two red blood cells. There was a surgical complication (wound of the inferior mesenteric artery). There were no early @entity260 and the median hospital stay was 6 days (3-24). There was a late @entity260 : a @entity1 who underwent anterior pelvic exenteration had @entity73 , with scarring requiring led by the VAC system. On pathological findings, the average number of nodes removed in the pelvic was 8.5 (  2) on the left, and 4 (  1.4) on the right. Three @entity1 had involved margins; it was an anterior pelvic exenteration and two colpectomy. There was no hospital mortality, neither post-operative mortality at D30 and D90. After a median follow up of 22 months (9-34), the recurrence rate was 71% (5 @entity1 out of 7), and one @entity1 died 10 months after the intervention of a @entity1151 . DISCUSSION AND CONCLUSION: The surgical management of recurrent cervical @entity5 by laparoscopy-assisted robot is feasible for selected indications, and could be proposed as an alternative to laparotomy. Monitoring data in this series raise the question of the validity of conservative treatment in cases of recurrent @entity5 . The possibilities in terms of urinary and vaginal reconstruction remain to be defined. The impact of this surgical approach on oncological data must be confirmed.
