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Study ObjectiveThe video article describes a laparoscopic anterior pelvic exenteration with radical vaginectomy using the 3-dimensional (3D) vision and multifunction instruments.MethodsThis is a step-by-step video presentation of the laparoscopic anterior pelvic exenteration (Canadian Task Force classification III). Although the therapeutic benefit of the PE remains controversial, it is often performed in women with centrally recurrent pelvic tumors that previously received radiation therapy or in the locally advanced cases (ie, stage IIb–IVa) resistant to radiochemotherapy. The patient was a 61-year-old woman (body mass index 31.8 kg/m2) with locally advanced squamous cervical cancer involving the bladder (International Federation of Gynecology and Obstetrics stage IVa) submitted to chemoradiotherapy with no response and was admitted for surgery. The preoperative positron emission tomography/computed tomography scan was negative for metastatic localizations.The surgery was performed including radical hysterectomy, cystectomy, and colpectomy with macroscopic resection margins larger than 2 cm; a subsequent Bricker’s ileal conduit was completed. An Endoeye Flex 3D Videoscope (Olympsus System) and Thunderbeat device were used to perform it.ResultsThe operation was performed successfully with no intraoperative or postoperative complications. Total duration of surgery was 330 minutes. The estimated blood loss was 100 mL. The patient was discharged on day 8. The pathology report was positive for relapse of cervical cancer (tumor diameter = 4 cm) with infiltration of the vagina and the posterior bladder’s muscle.ConclusionsLaparoscopic anterior pelvic exenteration with radical colpectomy using 3D vision and multifunction instrument is a fast and safe procedure. However, we notice that further prospective trials are needed to compare this technique with other open surgery and minimally invasive approach (ie, robotically).

This pilot study was aimed to value the feasibility and safety of Senhance Robotic Platform for hysterectomy in obese patients. Ten obese patients (30&nbsp

Objectives During the last decade endoscopic surgical procedures have been constantly evolving. The latest innovation in ultra-minimally invasive surgery (MIS) is the percutaneous technology (Percuvance™ Percutaneous Surgical System (PSS), Teleflex Inc., USA). We compared surgical outcome of hysterectomy, in a retrospective cohort study using the most recent MIS techniques as single-site (LESS) surgery, 3mm laparoscopy (MiniLPS) and percutaneous system (PSS) with standard laparoscopy (LPS). Study design This is a matched retrospective cohort study. Endometrial Hyperplasia/Early stage endometrial cancer or benign pathology were the indication for surgery. Data of laparoscopic hysterectomies performed between May 2013 and April 2016 using PSS, LPS, MiniLPS, and LESS were collected and compared. Results The characteristics of each group were similar. The median Operative time (OT) was significantly longer in LESS compared to all other groups (120min [range 55–165] in LESS, 91min [range 60–180] in MiniLPS, 70min [range 55–230] in LPS and 65 [range 40–180] in PSS; p=0.0001). No significant differences among the 4 groups were observed in terms of estimated blood loss, conversion to laparoscopy or laparotomy, and intra e post-operative complications. Statistically significant differences were recorded in median VAS 24h (2 [range 0–3] in PSS, 2 [range 0–3] in MiniLPS, 3 [range 2–5] in LESS and 2 [range 1–5] in LPS; p=0.0001). The average time of discharge was (1day [range 1–3] in PSS, 1day [range 1–2] in MiniLPS, 1days [range 1–2] in LESS and 1day [range 1–3] in LPS; p=0.99). Conclusions Data show that the effort to minimize the impact of surgical invasiveness can be feasible and could improve the advantages, not only in terms of aesthetic outcomes, even if the differences among the endoscopic approaches have not a relevant clinical impact. The technology innovations like PSS maintain the same triangulation between instruments as standard LPS with an evident decrease of the invasiveness thanks to reduced instruments size, even if the lack of suitability of bipolar energy, that require a multifunction instrument, remain a limit of these instruments.