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Javier F. Magrina - One of the best experts on this subject based on the ideXlab platform.
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Robotic Radical Hysterectomy: Surgical Technique
Minimally Invasive Gynecology, 2018Co-Authors: Antonio Gil-moreno, Javier F. MagrinaAbstract:Radical Hysterectomy remains the preferred method of treatment for patients with early cervical cancer (FIGO stages IA2-IB1-IIA1). The incorporation of robotic technology in the USA and other countries changed the avenue from laparotomy to a minimally invasive approach, something that laparoscopic technology did not fully do. Some of the major advantages of robot-assisted over conventional laparoscopy are its superior visualization (3D versus 2D) imaging of the operative field), its mechanical improvements such as its seven degrees of freedom (similar to the human arm and hand, while rigid conventional instruments have four degrees of freedom), the stabilization of instruments within the surgical field (in conventional laparoscopy, small movements by the surgeon are amplified including hand tremor), and its improved ergonomics for the operating surgeon. The technique of robotic Radical Hysterectomy or robotic-assisted Radical Hysterectomy will be described in this chapter. The reader must be knowledgeable of the indications, limitations, and location of metastatic nodes to indicate or not a robotic approach and to determine whether preoperative chemoradiotherapy is needed. Whenever chemoirradiation is contemplated, the Radical Hysterectomy should be avoided due to the increased morbidity of using both treatment modalities. In these cases systematic pelvic and aortic lymphadenectomy is done to limit the irradiation field.
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Robotic Radical Hysterectomy: Technical aspects
Gynecologic oncology, 2009Co-Authors: Javier F. Magrina, Rosanne M. Kho, Paul M. MagtibayAbstract:Abstract Objectives To describe the surgical technique of robotic Radical Hysterectomy. Methods Retrospective video review of the instrumentation and methodology employed in 21 robotic Radical hysterectomies for cervical cancer Stages IB–IIA. Results All Radical hysterectomies were performed with the use of three or four robotic arms, three or four robotic instruments and one assistant trocar. The mean operating time was 225.8 min; mean console time was 182.1 min; and mean docking time was 2.2 min. The mean blood loss was 174.6 ml, mean number of lymph nodes 26.2, and the mean length of hospital stay was 1.6 days. Conclusions Robotic technology facilitates the performance of robotic Radical Hysterectomy.
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robotic Radical Hysterectomy comparison with laparoscopy and laparotomy
Gynecologic Oncology, 2008Co-Authors: Javier F. Magrina, Amy L. Weaver, Regina P Montero, Paul M. MagtibayAbstract:Abstract Objective Comparison of perioperative results of patients undergoing Radical Hysterectomy by robotics, laparoscopy, and laparotomy. Study design Prospective analysis of 27 patients undergoing robotic Radical Hysterectomy between April 2003 and September 2006. Comparison was made with patients operated by laparoscopy and laparotomy matched by age, BMI, site and type of malignancy, FIGO staging, and type of Radical Hysterectomy. Results The mean operating times for patients undergoing robotic, laparoscopy and laparotomy Radical Hysterectomy were 189.6, 220.4, and 166.8 min, respectively; the mean blood loss was 133.1, 208.4, and 443.6 ml, respectively; the mean rate of blood loss was 0.7, 0.9, and 2.6 ml/min, respectively; the mean number of removed lymph nodes was 25.9, 25.9, and 27.7, respectively; and the mean length of hospital stay was 1.7, 2.4, and 3.6 days, respectively. There were no significant differences in intra- or postoperative complications among the three groups, no fistula formation in any patient and no conversions in the robotic or laparoscopic groups. At a mean follow up of 31.1 months, none of the patients with cervical cancer has experienced recurrence. Conclusion Laparoscopy and robotics are preferable to laparotomy for patients requiring Radical Hysterectomy. Operating times for robotics and laparotomy were similar, and significantly shorter as compared to laparoscopy. Blood loss, rate of blood loss and length of hospital stay were similar for laparoscopy and robotics and significantly reduced as compared to laparotomy.
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Modified Radical Hysterectomy: Morbidity and Mortality
Gynecologic oncology, 1995Co-Authors: Javier F. Magrina, Martha A. Goodrich, Amy L. Weaver, Karl C. PodratzAbstract:Among 375 patients who underwent a modified Radical Hysterectomy at the Mayo Clinic, the complication rate was 24%, and the operative mortality was 0.5%. When compared with Radical Hysterectomy, this procedure is associated with a lower overall incidence of complications, particularly those related to the urinary tract.
Paul M. Magtibay - One of the best experts on this subject based on the ideXlab platform.
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Robotic Radical Hysterectomy: Technical aspects
Gynecologic oncology, 2009Co-Authors: Javier F. Magrina, Rosanne M. Kho, Paul M. MagtibayAbstract:Abstract Objectives To describe the surgical technique of robotic Radical Hysterectomy. Methods Retrospective video review of the instrumentation and methodology employed in 21 robotic Radical hysterectomies for cervical cancer Stages IB–IIA. Results All Radical hysterectomies were performed with the use of three or four robotic arms, three or four robotic instruments and one assistant trocar. The mean operating time was 225.8 min; mean console time was 182.1 min; and mean docking time was 2.2 min. The mean blood loss was 174.6 ml, mean number of lymph nodes 26.2, and the mean length of hospital stay was 1.6 days. Conclusions Robotic technology facilitates the performance of robotic Radical Hysterectomy.
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robotic Radical Hysterectomy comparison with laparoscopy and laparotomy
Gynecologic Oncology, 2008Co-Authors: Javier F. Magrina, Amy L. Weaver, Regina P Montero, Paul M. MagtibayAbstract:Abstract Objective Comparison of perioperative results of patients undergoing Radical Hysterectomy by robotics, laparoscopy, and laparotomy. Study design Prospective analysis of 27 patients undergoing robotic Radical Hysterectomy between April 2003 and September 2006. Comparison was made with patients operated by laparoscopy and laparotomy matched by age, BMI, site and type of malignancy, FIGO staging, and type of Radical Hysterectomy. Results The mean operating times for patients undergoing robotic, laparoscopy and laparotomy Radical Hysterectomy were 189.6, 220.4, and 166.8 min, respectively; the mean blood loss was 133.1, 208.4, and 443.6 ml, respectively; the mean rate of blood loss was 0.7, 0.9, and 2.6 ml/min, respectively; the mean number of removed lymph nodes was 25.9, 25.9, and 27.7, respectively; and the mean length of hospital stay was 1.7, 2.4, and 3.6 days, respectively. There were no significant differences in intra- or postoperative complications among the three groups, no fistula formation in any patient and no conversions in the robotic or laparoscopic groups. At a mean follow up of 31.1 months, none of the patients with cervical cancer has experienced recurrence. Conclusion Laparoscopy and robotics are preferable to laparotomy for patients requiring Radical Hysterectomy. Operating times for robotics and laparotomy were similar, and significantly shorter as compared to laparoscopy. Blood loss, rate of blood loss and length of hospital stay were similar for laparoscopy and robotics and significantly reduced as compared to laparotomy.
Farr Nezhat - One of the best experts on this subject based on the ideXlab platform.
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New techniques in Radical Hysterectomy
Current opinion in obstetrics & gynecology, 2008Co-Authors: Konstantin Zakashansky, William H. Bradley, Farr NezhatAbstract:Purpose of reviewTo review the recent literature regarding modifications of abdominal Radical Hysterectomy as well as development of new approaches including laparoscopic, vaginal, and robotic Radical Hysterectomy.Recent findingsNerve-sparing Radical Hysterectomy technique allows for significant red
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Robotic Radical Hysterectomy versus total laparoscopic Radical Hysterectomy with pelvic lymphadenectomy for treatment of early cervical cancer.
JSLS : Journal of the Society of Laparoendoscopic Surgeons, 2008Co-Authors: Farr Nezhat, M.s. Datta, Liu C, Linus Chuang, Konstantin ZakashanskyAbstract:BACKGROUND AND OBJECTIVES To compare intraoperative, pathologic and postoperative outcomes of robotic Radical Hysterectomy (RRH) to total laparoscopic Radical Hysterectomy (TLRH) in patients with early stage cervical carcinoma. METHODS We prospectively analyzed cases of TLRH or RRH with pelvic lymphadenectomy performed for treatment of early cervical cancer between 2000 and 2008. RESULTS Thirty patients underwent TLRH and pelvic lymphadenectomy for cervical cancer from August 2000 to June 2006. Thirteen patients underwent RRH and pelvic lymphadenectomy for cervical cancer from April 2006 to January 2008. There were no differences between groups for age, tumor histology, stage, lymphovascular space involvement or nodal status. No statistical differences were observed regarding operative time (323 vs 318 min), estimated blood loss (157 vs 200 mL), or hospital stay (2.7 vs 3.8 days). Mean pelvic lymph node count was similar in the two groups (25 vs 31). None of the robotic or laparoscopic procedures required conversion to laparotomy. The differences in major operative and postoperative complications between the two groups were not significant. All patients in both groups are alive and free of disease at the time of last follow up. CONCLUSION Based on our experience, robotic Radical Hysterectomy appears to be equivalent to total laparoscopic Radical Hysterectomy with respect to operative time, blood loss, hospital stay, and oncological outcome. We feel the intuitive nature of the robotic approach, magnification, dexterity, and flexibility combined with significant reduction in surgeon's fatigue offered by the robotic system will allow more surgeons to use a minimally invasive approach to Radical Hysterectomy.
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Laparoscopic Radical Hysterectomy and laparoscopically assisted vaginal Radical Hysterectomy with pelvic and paraaortic node dissection.
Journal of gynecologic surgery, 1993Co-Authors: Farr Nezhat, Matthew O. Burrell, Carlos E. Ramirez, Charles E. Welander, Jesus Carrodeguas, Camran NezhatAbstract:ABSTRACT Nineteen women underwent laparoscopic Radical Hysterectomy or laparoscopically assisted vaginal Radical Hysterectomy, with pelvic node dissection and paraaortic node dissection when indicated. One procedure was converted to laparotomy due to equipment failure (at The University of Puerto Rico). There were two minor postoperative complications. The first, febrile morbidity resulting from a urinary tract infection, responded to medical therapy. The second was incisional bleeding, which was controlled with sutures applied using a local anesthetic. No major postoperative complications were noted, there have been no incidents of recurrence, and the follow-up results are encouraging. (J GYNECOL SURG 9:105, 1993)
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Laparoscopic Radical Hysterectomy with paraaortic and pelvic node dissection.
American journal of obstetrics and gynecology, 1992Co-Authors: Camran Nezhat, Farr Nezhat, Matthew O. Burrell, Benedict B. Benigno, Charles E. WelanderAbstract:We report the first case of a laparoscopic Radical Hysterectomy and paraaortic and pelvic lymphadenectomy to treat a stage IA2 carcinoma of the cervix. To our knowledge, a laparoscopic Radical Hysterectomy with laparoscopic paraaortic lymphadenectomy has not been previously described.
Jason D Wright - One of the best experts on this subject based on the ideXlab platform.
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Comparative effectiveness of minimally invasive and abdominal Radical Hysterectomy for cervical cancer
Gynecologic oncology, 2012Co-Authors: Jason D Wright, Thomas J. Herzog, William M Burke, Alfred I. Neugut, Sharyn N. Lewin, Dawn L. HershmanAbstract:Abstract Objective We analyzed the uptake, morbidity, and cost of laparoscopic and robotic Radical hysterectomies for cervical cancer. Methods We identified women recorded in the Perspective database with cervical cancer who underwent Radical Hysterectomy (abdominal, laparoscopic, robotic) from 2006 to 2010. The associations between patient, surgeon, and hospital characteristic and use of minimally invasive Hysterectomy as well as complications and cost were estimated using multivariable logistic regression models. Results We identified 1894 patients including 1610 (85.0%) who underwent abdominal, 217 (11.5%) who underwent laparoscopic, and 67 (3.5%) who underwent robotic Radical Hysterectomy were analyzed. In 2006, 98% of the procedures were abdominal and 2% laparoscopic; by 2010 abdominal Radical Hysterectomy decreased to 67%, while laparoscopic increased to 23% and robotic Radical Hysterectomy was performed in 10% of women (p Conclusion Uptake of minimally invasive Radical Hysterectomy for cervical cancer has been slow. Both laparoscopic and robotic Radical hysterectomies are associated with favorable morbidity profiles.
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primary therapy for early stage cervical cancer Radical Hysterectomy vs radiation
American Journal of Obstetrics and Gynecology, 2009Co-Authors: Nisha Bansal, Thomas J. Herzog, Richard E Shaw, William M Burke, Israel Deutsch, Jason D WrightAbstract:Objective We compared survival for women with early-stage cervical cancer who were treated with primary radiation or Radical Hysterectomy. Study Design Patients in the Surveillance, Epidemiology, and End Results database with stage IB1-IIA cervical cancer were examined. Radical Hysterectomy was compared with primary combination external-beam and brachytherapy radiation. Results A total of 4885 patients were identified. Multivariate analysis showed that Radical Hysterectomy was associated with a 59% reduction in mortality rate (hazard ratio, 0.41; 95% confidence interval [CI], 0.35–0.50). After stratification by tumor size, Hysterectomy was associated with a 62% reduction in mortality rate (hazard ratio, 0.38; 95% CI, 0.30–0.48) for tumors that were 6 cm in size, survival was equivalent between Radical Hysterectomy and radiation. Conclusion Our data indicate that, in women with cervical cancer lesions of
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optimizing the management of stage ii endometrial cancer the role of Radical Hysterectomy and radiation
American Journal of Obstetrics and Gynecology, 2009Co-Authors: Jason D Wright, William M Burke, Jessica Fiorelli, Amanda L Kansler, Peter B Schiff, Carmel J Cohen, Thomas J. HerzogAbstract:Objective The optimal management of stage II endometrial cancer remains uncertain. We examined the role of Radical Hysterectomy and adjuvant radiotherapy for stage II endometrial cancer. Study Design The Surveillance, Epidemiology, and End Results database was used to identify 1577 women with stage II endometrioid type endometrial adenocarcinoma who underwent surgical staging. Results The cohort included 1198 women who underwent simple Hysterectomy (76%) and 379 who underwent Radical Hysterectomy (24%). Radical Hysterectomy had no effect on survival (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.61-1.23). Patients who did not receive radiation were 48% (HR, 1.48; 95% CI, 1.14-1.93) more likely to die than those who underwent adjuvant radiotherapy. The survival benefit from radiation was most pronounced in women who underwent Radical Hysterectomy. Conclusion Adjuvant radiation improves survival. Although the routine performance of Radical Hysterectomy does not appear to be justified, patients with high-risk stage II tumors appear to benefit from combination therapy with Radical Hysterectomy and radiotherapy.
Thomas J. Herzog - One of the best experts on this subject based on the ideXlab platform.
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Comparative effectiveness of minimally invasive and abdominal Radical Hysterectomy for cervical cancer
Gynecologic oncology, 2012Co-Authors: Jason D Wright, Thomas J. Herzog, William M Burke, Alfred I. Neugut, Sharyn N. Lewin, Dawn L. HershmanAbstract:Abstract Objective We analyzed the uptake, morbidity, and cost of laparoscopic and robotic Radical hysterectomies for cervical cancer. Methods We identified women recorded in the Perspective database with cervical cancer who underwent Radical Hysterectomy (abdominal, laparoscopic, robotic) from 2006 to 2010. The associations between patient, surgeon, and hospital characteristic and use of minimally invasive Hysterectomy as well as complications and cost were estimated using multivariable logistic regression models. Results We identified 1894 patients including 1610 (85.0%) who underwent abdominal, 217 (11.5%) who underwent laparoscopic, and 67 (3.5%) who underwent robotic Radical Hysterectomy were analyzed. In 2006, 98% of the procedures were abdominal and 2% laparoscopic; by 2010 abdominal Radical Hysterectomy decreased to 67%, while laparoscopic increased to 23% and robotic Radical Hysterectomy was performed in 10% of women (p Conclusion Uptake of minimally invasive Radical Hysterectomy for cervical cancer has been slow. Both laparoscopic and robotic Radical hysterectomies are associated with favorable morbidity profiles.
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primary therapy for early stage cervical cancer Radical Hysterectomy vs radiation
American Journal of Obstetrics and Gynecology, 2009Co-Authors: Nisha Bansal, Thomas J. Herzog, Richard E Shaw, William M Burke, Israel Deutsch, Jason D WrightAbstract:Objective We compared survival for women with early-stage cervical cancer who were treated with primary radiation or Radical Hysterectomy. Study Design Patients in the Surveillance, Epidemiology, and End Results database with stage IB1-IIA cervical cancer were examined. Radical Hysterectomy was compared with primary combination external-beam and brachytherapy radiation. Results A total of 4885 patients were identified. Multivariate analysis showed that Radical Hysterectomy was associated with a 59% reduction in mortality rate (hazard ratio, 0.41; 95% confidence interval [CI], 0.35–0.50). After stratification by tumor size, Hysterectomy was associated with a 62% reduction in mortality rate (hazard ratio, 0.38; 95% CI, 0.30–0.48) for tumors that were 6 cm in size, survival was equivalent between Radical Hysterectomy and radiation. Conclusion Our data indicate that, in women with cervical cancer lesions of
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optimizing the management of stage ii endometrial cancer the role of Radical Hysterectomy and radiation
American Journal of Obstetrics and Gynecology, 2009Co-Authors: Jason D Wright, William M Burke, Jessica Fiorelli, Amanda L Kansler, Peter B Schiff, Carmel J Cohen, Thomas J. HerzogAbstract:Objective The optimal management of stage II endometrial cancer remains uncertain. We examined the role of Radical Hysterectomy and adjuvant radiotherapy for stage II endometrial cancer. Study Design The Surveillance, Epidemiology, and End Results database was used to identify 1577 women with stage II endometrioid type endometrial adenocarcinoma who underwent surgical staging. Results The cohort included 1198 women who underwent simple Hysterectomy (76%) and 379 who underwent Radical Hysterectomy (24%). Radical Hysterectomy had no effect on survival (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.61-1.23). Patients who did not receive radiation were 48% (HR, 1.48; 95% CI, 1.14-1.93) more likely to die than those who underwent adjuvant radiotherapy. The survival benefit from radiation was most pronounced in women who underwent Radical Hysterectomy. Conclusion Adjuvant radiation improves survival. Although the routine performance of Radical Hysterectomy does not appear to be justified, patients with high-risk stage II tumors appear to benefit from combination therapy with Radical Hysterectomy and radiotherapy.
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Radical Hysterectomy for cervical cancer in obese women.
Obstetrics & Gynecology, 2000Co-Authors: David E. Cohn, Elizabeth M. Swisher, Thomas J. Herzog, Janet S. Rader, David G. MutchAbstract:Abstract Objective: To estimate the morbidity, adequacy of surgery, and survival of obese women undergoing Radical Hysterectomy and pelvic lymphadenectomy. Methods: Patients with stage I and IIa cervical cancer and a body mass index (BMI) over 30 kg/m 2 and absolute weight greater than 85 kg explored with the intent for Radical Hysterectomy between 1986 and 1998 were identified. Patient characteristics, surgical, pathologic, and follow-up data were extracted and survival curves were generated. Results: Forty-eight obese women were identified who were explored for Radical Hysterectomy and pelvic lymph node dissection. The median BMI was 36 kg/m 2 , and the median weight was 95 kg. Thirty-five patients (73%) had stage Ib1 disease. Despite the obesity of the study group, none had severe comorbidity. The procedure was completed in 46 patients, and abandoned in two because of metastatic disease. For patients undergoing Radical Hysterectomy and pelvic lymph node dissection, median blood loss was 800 mL. No patient developed fistulas. Residual tumor was present in 26 (57%) Hysterectomy specimens, and margins were without disease in 45 specimens (98%). A median of 26 pelvic lymph nodes were obtained per procedure, and six patients (13%) had positive nodes. Five-year overall and disease-free survival are 84% (95% confidence interval [CI] 70.9, 97.5) and 80% (95% CI 65.2, 93.8), respectively, at a median follow-up of 36 months. Conclusion: In this carefully selected obese group, we demonstrate that Radical Hysterectomy and pelvic lymph node dissection can be performed with adequate surgical resection, acceptable morbidity, and excellent survival.
