Abstract:
Introduction: Laparoscopy has been a boon to mankind. Its first use has evolved during the 80’s & 90’s only for benign diseases. Over the years, it has evolved in complex cancer surgeries mainly abdominal & thorasic cancers. Last 10 years has seen the outcomes of minimally invasive cancer surgeries & its advantages to open surgeries with the advances in technology-instruments & techniques specially for colorectal, gynecology & gastrointestinal cancers.
We started our laparoscopy career in 2010 & started off with benign surgeries & eventually started minimally invasive cancer surgeries in rural western India. The most common cancer in India in females is still cervical cancers & the main reason is poor socioeconomic class - poor personal hygiene leading to HPV virus infection & white discharge – lack of knowledge & lack of facilities in rural India – leading to late detection. In the last 12 years, as a single private institute for cancer, we have developed techniques & facilities for the poor patients making minimally invasive surgeries affordable for all by cost cutting methods & quality assurance along with abiding to oncologic principles – catering to over 20 lakh population covering a distance of 200 sq kms between two major cities of Mumbai & Surat- where the next nearest cancer facilities are available. This presentation shall share the experience of evolution from a basic laparoscopic centre doing benign work to eventually developing a cancer institute & robotic centre in a rural place along with developing a training academy for gynecologists for minimally invasive cancer surgeries – a pure hands-on experience. An experience of over 6000 benign gynecology (fertility enhancing & radical) laparoscopic procedures & 350 plus laparoscopic cancer cases in a single institute in rural India. The first use of laparoscopic methods in gynecologic oncology dates back to the 1970s.Initially, laparoscopy was used as diagnostic tool for preoperative staging in patients with ovarian carcinoma. In 1990 Querleu first reported on the use of laparoscopy in pelvic lymphadenectomy procedures in patients with cervical cancer. Other reports soon followed, including a study on laparoscopy in paraaortic lymph node sampling, published by Herd an colleagues in 1992, and a publication in the same year by Nezhat et al. on laparoscopic radical hysterectomy to treat cervical carcinoma
Aims & Objectives: To create a data base for knowing the short and long term advantages and disadvantages of laparoscopic radical hysterectomy for CA cervix with review of literature and discussing pelvic laparoscopic anatomy.
Material & Methods: 144 cases of laparoscopic radical hysterectomy were operated at our centre between 2012-2018. Intra operative, pre and post operative parameters were noted. The technique of doing the surgery was the “Pune” technique, described by dr shailesh puntambekar. Short and long term post operative survival data and complications were analized.
Results: 144 cases of early ca cervix were operated by laparoscopic radical hysterectomy. Average operative time was 165min. average blood loss was 140ml. average hospital stay was 3 days. Vaginal margin was 2 cms.12 patients had recurrence at the end of 5years followup. Few complications were encountered.
Conclusions: Laparoscopic radical hysterectomy is here to stay and has sure short and long term benefits and comparable survival data compared to open surgeries. Better vision, better magnification, immediate post op recovery and lesser complications was seen. Over 10 years of experience & follow up is discussed, but have had an exciting experience with the technique and would love to discuss in the forum.
Audience Take Away Notes:
This presentation shall discuss our exp with lap radical hysterewctomy for ca cervix in a high volume centre in rural india- the laparoscopic techniques for benign and cancer cases – share the experience of time taken to evolve from benign to cancer surgeries – share the numbers -complications & follow up of the cases and inspire & encourage surgeons to evolve into minimally invasive cancer pelvic surgeries. It will also touch the problems we faced in evolving in a rural place away from cities & inspire young surgeons to settle in rural places & not cities. It will show how a small team can do multiple things in a small place and still give good services with care & ethics. The author is a trainer in gynec endoscopy as well & trained over 600 gynecologists in last 6 years – he is one of the few who gives pure hands-on training to doctors on patients for evolving laparoscopy. This presentation shall encourage people to share their knowledge- be open to sharing & replicating by standardizing the technique & steps inspiring youngsters to start teaching.
