1,721,130 research outputs found
ASO Author Reflections: Minimally Invasive Adjuvant Surgery in Locally Advanced Cervical Cancer: Which Role?
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Minilaparoscopic nerve sparing radical hysterectomy in locally advanced cervical cancer after neoadjuvant radiochemotherapy
No full textObjective We report the technique to performminilaparoscopic nerve sparing radical hysterectomy (NSRH) in locally advanced cervical cancer. Methods Three patients aged 32, 53, and 51 respectively (median 46), with a median body mass index of 23 (18-26), one nulliparous and two pluriparous, were diagnosed with cervical squamous carcinoma on cervical biopsy, FIGO stage II B, and underwent a minilaparoscopic NSRH, bilateral salpingo-oophorectomy and systematic pelvic lymphadenectomy after neoadjuvant radiochemotherapy (pelvic irradiation in 22 fractions 1.8 Gy/day, totaling 39.6 Gy in combination with cisplatin 20 mg/m 2, 2-h intravenous infusion and 5-fluorouracil 1000 mg/m 2, 24-h continuous intravenous infusion, both on days 1-4 and 27-30) according to a protocol in our Institution [1,2]. Operative technique The procedures required a 5 mm 0 endoscope (Endoeye, Olympus Winter& Ibe GmbH, Hamburg-Germany) inserted in a trans-umbilical optical viewing port (Endopath Xcel, Ethicon Endo-surgery, Cincinnati, OH) and three additional sovrapubic 3-mm diameter ports placed. Three millimeter instruments were employed including atraumatic graspers, monopolar scissors, a suction-washing system (Karl Storz Endoskope-3 mm Instrument set, Tuttlingen Germany) and bipolar coagulator (Robi, Karl Storz). As already described, after pelvic and abdominal exploration, the operation starts with the coagulation and transection of the round ligament next to the pelvic wall and the opening of the anterior and posterior peritoneal layers of the broad ligament in order to enter the pelvic retroperitoneum. Once developed the paravesical and pararectal spaces the ureter can be easily identified. The uterine artery is then isolated and coagulated at its origin from umbilical artery. Before starting the pelvic lymphadenectomy, the dissection of the paravesical space laterally to the obliterated umbilical artery needs to be completed until the obturator nerve is identified. External and common iliac lymph nodes are removed from vessel surfaces by blunt or sharp dissection. Moreover, the obturator fossa is entered laterally and the obturator nerve and vessels are skeletonized before removing superficial and deep obturator lymph nodes. The anatomical margins for the pelvic lymph node dissection are medially the ureter, laterally the psoas muscle and the genitofemoral nerve, posteriorly the obturator nerve and cranially the mid portion of the common iliac artery. The same procedure was performed on the controlateral side. Once the ureter is identified, the infundibulopelvic ligament can be coagulated and transected. The pararectal space is then developed in a medial portion (Okabayashi space) and in a lateral portion (Latzko space), having the ureter in the middle. This maneuver allows the surgeon to identify the inferior hypogastric nerve, that appears approximately 2-3 cm dorsally of the ureter in the lateral part of the uterosacral ligament when entering the lateral parametrium. After its identification, this nerve is followed until it runs dorsally to the deep uterine vein. At this point the pelvic splanchnic nerves running from the S2-S4 roots of the sacral plexus join in the inferior hypogastric plexus with the inferior hypogastric nerves. After the identification of the above mentioned nerve structures, we performed a radical resection of the uterosacral and paracervical tissues according to the nerve sparing technique [3,4]. The paracervical tissue and the uterosacral ligaments were transected combining monopolar and bipolar devices with the vessel by vessel technique. Dissection of the ureteral tunnel and vesicovaginal spaces was accomplished with monopolar and blunt technique and with the aid of bipolar coagulation. At that point, the vaginal wall was identified and transected with a monopolar hook using pure section energy to avoid postoperative ureteral and bladder complications. The specimens were removed vaginally. The vaginal cuff was then closed transvaginally. A hydropneumatic test for bladder integrity was performed at the end of the procedure. The laparoscopic access points were only closed by steri-strips. Results All surgical procedures were completed as planned. Median operative time was 192 min (173-217) and the estimated blood loss was less than 50 mL in all cases. No post-operative complications occurred. Post-void residual was less than 100 mL in post-operative day 2. All patients were discharged on postoperative day 3. The pathology report revealed a median residual tumor of 8 mm (6-12) in all cervical specimens. The median width of parametrical tissue and length of vaginal cuff were 23 mm (20-27) and 18 mm (15-24), respectively. A median of 26 (21-33) lymph nodes had been harvested and were negative for metastasis. None of these three patients required adjuvant treatment. Over a median follow-up of 10 months all patients had no evidence of disease. Conclusions This surgical video testifies the technical feasibility ofminilaparoscopy NSRH producing surgico-pathologic data in line with what has recently been published [5,6]
Minilaparoscopic aortic lymphadenectomy
No full textStudy Objective: To show the feasibility of performing aortic lymphadenectomy with 3-mm instruments in gynecologic malignancies. Patient: A 43-year-old, multiparous patient with serous ovarian cancer grading 2, Fédération Internationale de Gynécologie et d'Obstétrique stage IC (intraoperative spillage). Intervention: The patient was accidentally diagnosed with ovarian cancer after a right adnexectomy performed for an ovarian cyst. Once referred to our center, a delayed surgical staging was planned including total hysterectomy, left adnexectomy, aortic and pelvic lymphadenectomy, peritoneal biopsies, and total omentectomy. Minilaparoscopy was believed to be feasible to achieve it. Measurements and Main Results: The operation was performed successfully with no intraoperative or postoperative complication. Operative time was 150minutes overall, and blood loss was 50mL. Twenty-three aortic lymph nodes were removed. The pathology report came back clean. The patient was discharged on day 1 and 10days later started adjuvant chemotherapy. After 16months, no recurrence was detected. Conclusion: Minilaparoscopy aortic lymphadenectomy is technically feasible when performed by trained surgeons
Robotic video endoscopic inguinal lymphadenectomy (R-VEIL) for vulvar cancer with sentinel node mapping using indocyanine green and near-infrared fluorescence imaging technology
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Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Robotic versus laparoscopic surgery in gynecology: Which should we use?
No full textThis review of the literature aims at assessing the safety and effectiveness of robotic versus laparoscopic surgery in benign and malignant gynecological diseases. Robotic-assisted laparoscopy is already widely used in the United States and Europe for the main gynecological procedure - hysterectomy - and has proved feasible and comfortable for other benign and malignant gynecological procedures. However, the clinical effectiveness and safety of robotic surgery compared with standard laparoscopy have not been undoubtedly established. We reviewed the literature by searching in the Ovid/MEDLINE, PubMed, Cochrane Library, and Google Scholar databases for all the articles published from January 1995 to September 2015. More rigorous experimental studies are needed, that compare robotic-assisted surgery and laparoscopic surgery for gynecological diseases. However, current data seem to encourage the use of minimally-invasive surgery to treat benign and malignant gynecological diseases
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