Uterine manipulator in endometrial cancer: a video is worth a ......2020/12/03 · Int J Gynecol...
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1 Padilla-Iserte P, et al. Int J Gynecol Cancer 2020;0:1. doi:10.1136/ijgc-2020-002011 Uterine manipulator in endometrial cancer: a video is worth a thousand words Pablo Padilla-Iserte, Raquel Quintana, Tiermes Marina, Victor Lago, Luis Matute, Santiago Domingo Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain Correspondence to Dr Pablo Padilla-Iserte, Department of Gynecology Oncolgy, La Fe University and Polytechnic Hospital, Valencia 46026, Spain; pablo_iserte@ hotmail.com Accepted 16 November 2020 To cite: Padilla-Iserte P, Quintana R, Marina T, et al. Int J Gynecol Cancer Published Online First: [please include Day Month Year]. doi:10.1136/ ijgc-2020-002011 Video article © IGCS and ESGO 2020. No commercial re-use. See rights and permissions. Published by BMJ. Original research Editorials Joint statement Society statement Meeting summary Review articles Consensus statement Clinical trial Case study Video articles Educational video lecture Corners of the world Commentary Letters ijgc.bmj.com INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER The uterine manipulator is a device commonly used in minimally invasive hysterectomy procedures for benign disease to facilitate uterus mobilization during surgery, generate tension on the main supporting elements of the uterus (broad ligament, uterine vessels, and uterosacral ligaments) to improve surgical field exposure, and provide a landmark for the colpotomy. Nonetheless, the use of a uterine manipulator has not been demonstrated to reduce surgical complications. 1 With the introduction of minimally invasive approaches in gynecological oncology treatments, this uterine device has been utilized for endometrial and cervical cancers. Without substantial evidence to support its use, surgeons are required to make decisions about using the uterine manipulator in oncological patients based on their surgical experience. In cervical cancer the LACC (Laparoscopic Approach to Cervical Cancer) trial has shown a worse, unexpected oncological outcome after a minimally invasive surgery approach in early-stage cervical cancer. 2 One of the hypotheses generated was that the uterine manipulator might influence this worse prognosis. The retrospective SUCCOR trial—an international European cohort observa- tional study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer—showed that patients with early stage cervical cancer who underwent minimally invasive surgery using a uterine manipulator had a higher relapse rate than the group undergoing minimally invasive surgery without use of a uterine manipulator, resulting in the same oncolog- ical outcomes as patients with open surgery. 3 In endometrial cancer, the current evidence derives from retrospective studies with limited sample sizes. A recent multicenter study evaluating uterine manipulator use in early stage endometrial cancer by minimally invasive surgery found a higher recurrence rate with a worse onco- logic outcome in patients with uterus-confined endometrial cancer (International Federation of Gynecology and Obstet- rics (FIGO) I-II), which questions the safety of the uterine manipulator in endometrial cancer. 4 We present a video detailing the interaction between a tumor and the uterine device. The uterine manipulator is inserted vaginally through the cervical canal into a cavity lined with neoplastic tissue. This video displays the macro- scopic interaction during uterus mobilization in surgery and its effect on the surgical specimen. The demonstration allows a real, compressive, and visual evaluation of the uterine tumor–uterine manipulator relationship in endome- trial cancer. Twitter Tiermes Marina @Tiermes Contributors All authors have actively participated in the elaboration of the manuscript. PP-I: video edition, video locutation, abstract. RQ,TM, VL, LM: designs and review of the video and abstract. SD:abstract, designs and review of the video. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Competing interests None declared. Patient consent for publication Not required. Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement All data relevant to the study are included in the article. REFERENCES 1 van den Haak L, Alleblas C, Nieboer TE, et al. Efficacy and safety of uterine manipulators in laparoscopic surgery: a review. Arch Gynecol Obstet 2015;292:1003–11. 2 Ramirez PT, Frumovitz M, Pareja R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med Overseas Ed 2018;379:1895–904. 3 Chiva L, Zanagnolo V, Querleu D, et al. SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer. Int J Gynecol Cancer 2020;30:ijgc-2020- 001506. 4 Padilla-Iserte P, Lago V, Tauste C, et al. Impact of uterine manipulator on oncological outcome in endometrial cancer surgery. Am J Obstet Gynecol 2020;S0002- 9378:30744–4. Video 1 Relationship between the uterine manipulator and endometrial tumor. on June 6, 2021 by guest. Protected by copyright. http://ijgc.bmj.com/ Int J Gynecol Cancer: first published as 10.1136/ijgc-2020-002011 on 4 December 2020. Downloaded from
Transcript of Uterine manipulator in endometrial cancer: a video is worth a ......2020/12/03 · Int J Gynecol...
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1Padilla- Iserte P, et al. Int J Gynecol Cancer 2020;0:1. doi:10.1136/ijgc-2020-002011
Uterine manipulator in endometrial cancer: a video is worth a thousand words
Pablo Padilla- Iserte, Raquel Quintana, Tiermes Marina, Victor Lago, Luis Matute, Santiago Domingo
Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
Correspondence toDr Pablo Padilla- Iserte, Department of Gynecology Oncolgy, La Fe University and Polytechnic Hospital, Valencia 46026, Spain; pablo_ iserte@ hotmail. com
Accepted 16 November 2020
To cite: Padilla- Iserte P, Quintana R, Marina T, et al. Int J Gynecol Cancer Published Online First: [please include Day Month Year]. doi:10.1136/ijgc-2020-002011
Video article
© IGCS and ESGO 2020. No commercial re- use. See rights and permissions. Published by BMJ.
Original research
Editorials
Joint statement
Society statement
Meeting summary
Review articles
Consensus statement
Clinical trial
Case study
Video articles
Educational video lecture
Corners of the world
Commentary
Letters
ijgc.bmj.com
INTERNATIONAL JOURNAL OF
GYNECOLOGICAL CANCER
The uterine manipulator is a device commonly used in minimally invasive hysterectomy procedures for benign disease to facilitate uterus mobilization during surgery, generate tension on the main supporting elements of the uterus (broad ligament, uterine vessels, and uterosacral ligaments) to improve surgical field exposure, and provide a landmark for the colpotomy. Nonetheless, the use of a uterine manipulator has not been demonstrated to reduce surgical complications.1
With the introduction of minimally invasive approaches in gynecological oncology treatments, this uterine device has been utilized for endometrial and cervical cancers. Without substantial evidence to support its use, surgeons are required to make decisions about using the uterine manipulator in oncological patients based on their surgical experience.
In cervical cancer the LACC (Laparoscopic Approach to Cervical Cancer) trial has shown a worse, unexpected oncological outcome after a minimally invasive surgery approach in early- stage cervical cancer.2 One of the hypotheses generated was that the uterine manipulator might influence this worse prognosis. The retrospective SUCCOR trial—an international European cohort observa-tional study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer—showed that patients with early stage cervical cancer who underwent minimally invasive surgery using a uterine manipulator had a higher relapse rate than the group undergoing minimally invasive surgery without use of a uterine manipulator, resulting in the same oncolog-ical outcomes as patients with open surgery.3
In endometrial cancer, the current evidence derives from retrospective studies with limited sample sizes. A recent multicenter study evaluating uterine manipulator use in early stage endometrial cancer by minimally invasive surgery found a higher recurrence rate with a worse onco-logic outcome in patients with uterus- confined endometrial cancer (International Federation of Gynecology and Obstet-rics (FIGO) I- II), which questions the safety of the uterine manipulator in endometrial cancer.4
We present a video detailing the interaction between a tumor and the uterine device. The uterine manipulator is inserted vaginally through the cervical canal into a cavity lined with neoplastic tissue. This video displays the macro-scopic interaction during uterus mobilization in surgery and its effect on the surgical specimen. The demonstration allows a real, compressive, and visual evaluation of the uterine tumor–uterine manipulator relationship in endome-trial cancer.
Twitter Tiermes Marina @Tiermes
Contributors All authors have actively participated in the elaboration of the manuscript. PP- I: video edition, video locutation, abstract. RQ,TM, VL, LM: designs and review of the video and abstract. SD:abstract, designs and review of the video.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not- for- profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article.
REFERENCES 1 van den Haak L, Alleblas C, Nieboer TE, et al. Efficacy and
safety of uterine manipulators in laparoscopic surgery: a review. Arch Gynecol Obstet 2015;292:1003–11.
2 Ramirez PT, Frumovitz M, Pareja R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med Overseas Ed 2018;379:1895–904.
3 Chiva L, Zanagnolo V, Querleu D, et al. SUCCOR study: an international European cohort observational study comparing minimally invasive surgery versus open abdominal radical hysterectomy in patients with stage IB1 cervical cancer. Int J Gynecol Cancer 2020;30:ijgc-2020-001506.
4 Padilla- Iserte P, Lago V, Tauste C, et al. Impact of uterine manipulator on oncological outcome in endometrial cancer surgery. Am J Obstet Gynecol 2020;S0002-9378:30744–4.
Video 1 Relationship between the uterine manipulator and endometrial tumor.
on June 6, 2021 by guest. Protected by copyright.
http://ijgc.bmj.com
/Int J G
ynecol Cancer: first published as 10.1136/ijgc-2020-002011 on 4 D
ecember 2020. D
ownloaded from
http://bmjopen.bmj.com/http://crossmark.crossref.org/dialog/?doi=10.1136/ijgc-2020-002011&domain=pdf&date_stamp=2020-11-04https://twitter.com/Tiermeshttp://dx.doi.org/10.1007/s00404-015-3727-9http://dx.doi.org/10.1056/NEJMoa1806395http://dx.doi.org/10.1136/ijgc-2020-001506http://dx.doi.org/10.1016/j.ajog.2020.07.025https://brightcove.hs.llnwd.net/v1/uds/pd/2696240571001/202011/2621/2696240571001_6211665260001_6211665345001.mp4?pubId=2696240571001&videoId=6211665345001https://brightcove.hs.llnwd.net/v1/uds/pd/2696240571001/202011/2621/2696240571001_6211665260001_6211665345001.mp4?pubId=2696240571001&videoId=6211665345001http://ijgc.bmj.com/
Anaphylaxis management: a survey of school and day care nurses in LebanonAbstract
Uterine manipulator in endometrial cancer: a video is worth a thousand wordsReferences
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