Investigator
Bakent University
Laparoscopic para-aortic lymphadenectomy: Technique and surgical outcomes
Pelvic and para-aortic lymph node dissection is an important part of staging surgery. Aim of this study is to evaluate perioperative outcomes of patients, who underwent laparoscopic para-aortic lymphadenectomy for gynecological cancer in a single center over a period of 7 years, based on body mass index (BMI), and to present the surgical technique in steps. Data of patients who underwent para-aortic lymphadenectomy at gynecological oncology department of a tertiary center in between March 2013 and July 2020 were analyzed retrospectively. Patients were evaluated in two groups according to their BMI (< 30 kg/m A total of 230 patients were included in the study. BMI was ≥30 at 58.46 % of the patients. Peri-operative features were not significantly affected by the patient's BMI with the presented surgical technique, however, collected para-aortic lymph node numbers were higher in the group with BMI < 30, though sufficient number of lymph nodes were achieved in both groups. Although some technical difficulties may be encountered, laparoscopic para-aortic lymphadenectomy is feasable in gynecologic oncological surgery independent of BMI. However, surgical experience is important.
Impact of Power Morcellation and Histopathological Subtypes on the Development of Peritoneal Leiomyomatosis Following Laparoscopic Myomectomy
ABSTRACT Aim Laparoscopic myomectomy with power morcellation is a common approach for the management of uterine myomas. However, besides myoma recurrence, rare complications such as peritoneal leiomyomatosis may arise postoperatively. The histopathological subtype of fibroids—particularly cellular leiomyoma—may impact the risk of recurrence and dissemination, though current evidence remains limited. The aim of this study is to evaluate the impact of power morcellation on the development of disseminated peritoneal leiomyomatosis and to assess the association between the histopathological subtype of myoma and patient outcomes during follow‐up. Methods This retrospective cohort study analyzed 997 patients who underwent laparoscopic myomectomy with power morcellation at a single tertiary center between 2012 and 2024. Patients were followed through clinical evaluations and ultrasonography. Peritoneal leiomyomatosis was evaluated in relation to surgical technique (confined vs. unconfined morcellation) and histopathological subtype. Results Of the 553 patients with available follow‐up, myoma recurrence was observed in 130 (23.5%), reoperation in 53 (9.6%), and peritoneal leiomyomatosis in 8 patients (1.4%). All peritoneal leiomyomatosis cases occurred in the unconfined morcellation group. Cellular leiomyoma was identified in 5 of the 8 peritoneal leiomyomatosis cases (62.5%). One peritoneal leiomyomatosis case was diagnosed as leiomyosarcoma after surgery for disseminated leiomyomatosis. Overall myoma recurrence was significantly higher in patients with multiple myomas and in those with cellular leiomyoma. Conclusion Peritoneal leiomyomatosis is a rare complication of laparoscopic myomectomy and increased incidence after unconfined morcellation is a serious concern. Confined (in‐bag) morcellation appears to reduce the risk of peritoneal leiomyomatosis and should be the standard of care. Diagnosis of myomas as cellular leiomyoma subtype on histopathology merits high clinical suspicion for possibility of subsequent peritoneal leiomyomatosis in patients with unconfined morcellation. Therefore, close and long‐term follow‐up of these patients is essential.
