ABSTRACTS 775

21 September 2012: 08:00 e 08:45

Meet the expert breakfast: Publishing (EJSO) workshop

130. Publishing (EJSO) workshop

Abstract not submitted.

21 September 2012: 08:00 e 08:45

Meet the expert breakfast: Melanoma surgery

131. Melanoma surgery

S. Schneebaum1

1 Tel-Aviv Medical Center, Department of Surgery, Tel Aviv, Israel

The incidence of melanoma is increasing throughout the world at

a rate of approximately 5% per year. In the United States and Canada, mel-

anoma has increased at a rate exceeding that of any other tumor except

lung cancer in women.

Surgical treatment is the main treatment of primary melanoma and has

also an important role in treatment of metastatic melanoma.

Treatment of primary melanoma includes wide excision and sentinel

node biopsy .The sentinel node is the lymph node nearest the primary tu-

mor site on the direct drainage pathway. The sentinel node is the most

likely site of early metastasis.

The surgical technique will be discussed. The importance of scinti-

graphic sentinel node mapping prior to surgery is enhanced in tumors lo-

cated in body parts with ambiguous lymph node drainage such as the trunk,

shoulder, and the head and neck.

The use of single photon emission computed tomography camera with

integrated radiographic computed tomography (SPECT/CT) is of special

help and examples will be presented.

Discussion will be directed to current status of sentinel node treatment

and the special immunologic character of the sentinel node. Other issues

will be data supporting of its use and the rising question about completion

lymph node dissection.

Some discussion will be directed to pitfalls in performing wide exci-

sion of the primary lesion.

Treatment of metastatic lesions will be discussed:

The AJCC staging criteria defines sub stages of stage IV melanoma

based on the site of metastases: M1a (soft tissue or nodal recurrence),

M1b (lung), M1c(other).

Complete surgical resection can result in favorable overall survival for

M1a and M1b Stage 4, between 15 and 50 Mts. and 5-year survival rates of

14% and 61% in patients with M1a, and a median survival from 18 to 28

Mts. and 5 year survival of 14% to 50% for M1b. With less favorable re-

sults for M1c except for single small bowel metastasis.

Cytoreductive Surgery, a new approach to multiple site metastatic mel-

anoma, is based on reduced morbidity & mortality from surgical proce-

dures (<1%), on improved staging allowing better distinction between

single vs. multiple Mets.: CT, MRI & PET and due to the fact that most

patients (80%) have only 1-3 initial synchronous met sites.

Studying adjuvant specific active immunotherapy in the minimal resid-

ual disease setting is scientifically appealing.

Results of such studies will be presented, and future directions will be

discussed, especially in the light of new treatment modalities.

21 September 2012: 09:00 e 10:30

Symposium: Robot assisted surgery in pelvis (Joint ESSO/EAU)

132. Robot assisted surgery e Gynaecology

P. Pakarinen1

1 Helsinki University Hospital, OB GYN, Helsinki, Finland

The objective of the presentation is to review the published literature

regarding robotic gynecologic surgery with special reference to practical,

individualized patient care. Own results are presented: robotic surgery in

comparison with traditional laparoscopy in myomectomy and endometrial

cancer staging.

Though mini-invasive surgery is a recommendable manner of approach

in both gynecologic benign and oncologic surgery, only a minority of gy-

necologic operations is performed by laparoscope. Robot provides us

a tool to perform laparoscopic surgery similarly to open surgery.

Robot adds benefits to conventional laparoscopy; three-dimensional

view, greater dexterity, and tremor filtration. With surgeon’s easy move-

ments it is possible to reach narrow spaces with the camera and work

with the instruments easily and safely. The ergonomics of the surgeon is

totally improved from the laborious positions and static muscle work be-

side the patient in conventional laparoscopy.

The disadvantages often referred in robotic surgery include high costs,

demanding training of the whole team, lack of tactile feedback and also

decrease in cosmetics because of wider and more cranially located trocars.

From an other perspective, training provides co-operation and profession-

alism needed to adopt new techniques and should be a common practice in

operation rooms. Lack of tactile is compensated by a better view and as-

sistants’ possibility to feel tissues by conventional laparoscopic instru-

ments. The positioning and wideness of wounds should be considered

carefully to have best possible results in cosmetics.

Due to limited and often with other specialties shared robotic surgery

resources, operations have to be prioritized to robotic assisted or conven-

tional laparoscopy cost-consciously.

The Cochrane systematic review does not currently support the use of

robotic surgery in benign gynecological disease, particularly for sacrocol-

popexy and hysterectomy. However, reviewers point out that as the data

available is limited; conclusions should be drawn with caution. Today, in

the perspective of clinician, the robot might still be beneficial also in be-

nign surgery if replacing laparotomy.

In a recent study gynecologic oncologists evaluated robotic as good as

laparoscopic surgery in the management of both early stage cervical and

endometrial cancers. Cochrane review concluded parallel that the studies

available support the use of robotic assisted surgery for endometrial cancer

and cervical cancer.

The cost analysis in retrospective comparative studies often shows the

highest costs concerning open surgery and lowest in laparoscopic surgery.

The costs of robotic surgery seem to settle in between. The randomized

clinical trials with statistical power are needed to show the long-term sig-

nificance of robotic assisted laparoscopy in cancer survival, patients’ qual-

ity of life, costs as well as well-being of personnel.