RESUMEN
OBJECTIVE: The objective of this study was to describe the technique of laparoscopic hysterectomy using a computer-enhanced robotic surgical system. METHODS: Eleven patients underwent laparoscopic hysterectomy and bilateral salpingo-oophorectomy using a computer-enhanced surgical robot. Four trocars were used: one for the camera, two for the robotic arms controlled by the operating surgeon from the surgeon's console, and an additional port for use by the surgical assistant. RESULTS: Ages ranged from 27 to 77 years, and weight ranged from 54 to 100 kg. Operative time ranged from 4.5 to 10 hours. Estimated blood loss ranged from 50 to 1500 ml. The patients tolerated the procedure and recovered satisfactorily. CONCLUSION: This is the first case series reporting the use of a computer-enhanced surgical robot for performing hysterectomy in humans. It is feasible and well tolerated in this series of patients. As this technology develops, the applications for its use in gynecology and gynecologic oncology will increase.
Asunto(s)
Histerectomía/instrumentación , Histerectomía/métodos , Laparoscopía/métodos , Robótica/métodos , Cirugía Asistida por Computador/métodos , Adulto , Anciano , Pérdida de Sangre Quirúrgica , Femenino , Humanos , Persona de Mediana Edad , Ovariectomía/instrumentación , Ovariectomía/métodos , Robótica/instrumentación , Cirugía Asistida por Computador/instrumentación , Factores de TiempoRESUMEN
OBJECTIVE: To assess the clinical and molecular response of patients with recurrent high-grade vulvar, vaginal, or cervical intraepithelial neoplasia treated with topical 1-2(2-methylpropyl)-1H-imidazo [4,5-c] quinolin-4-amine (imiquimod) cream 5%, an immune response modifier with known efficacy in the treatment of external genital warts. METHODS: This is the first case series in the peer-reviewed literature reporting the use of imiquimod in high-grade intraepithelial neoplasia of the lower genital tract. Eight patients with high-grade intraepithelial neoplasia were treated with imiquimod in the gynecological oncology clinic and the HIV gynecology clinic at The University of Texas Medical Branch at Galveston. Frozen biopsies were available for RNA extraction on four patients before and after therapy. Using semiquantitative reverse transcription-PCR, we measured RNA levels of IFNs alpha and gamma, 2',5'-oligoadenylate synthetase, as well as CD4 and CD8 lymphocyte markers. RESULTS: Of the patients treated, four had complete responses, two had partial responses, one progressed, and one did not tolerate the therapy. Of the four complete responders, two remained disease-free (mean follow-up, 33 months). 2',5'-Oligoadenylate synthetase RNA expression showed an increased trend after therapy. CONCLUSIONS: These results obtained in this small and heterogeneous group merit further study in the use of topical 5% imiquimod use in the treatment of intraepithelial neoplasia. An important mechanism of action of imiquimod may involve 2',5'-oligoadenylate synthetase antiviral activity.
Asunto(s)
Aminoquinolinas/uso terapéutico , Antineoplásicos/uso terapéutico , Neoplasias de los Genitales Femeninos/tratamiento farmacológico , Displasia del Cuello del Útero/tratamiento farmacológico , 2',5'-Oligoadenilato Sintetasa/genética , Administración Tópica , Adulto , Femenino , Estudios de Seguimiento , Regulación Enzimológica de la Expresión Génica/efectos de los fármacos , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Humanos , Imiquimod , Persona de Mediana Edad , Pomadas , ARN Neoplásico/genética , ARN Neoplásico/metabolismo , Factores de Tiempo , Resultado del Tratamiento , Neoplasias del Cuello Uterino/tratamiento farmacológico , Neoplasias del Cuello Uterino/genética , Neoplasias Vaginales/tratamiento farmacológico , Neoplasias Vaginales/genética , Neoplasias de la Vulva/tratamiento farmacológico , Neoplasias de la Vulva/genética , Displasia del Cuello del Útero/genéticaRESUMEN
BACKGROUND: Non-Hodgkin lymphoma has become a common malignancy in patients infected with the human immunodeficiency virus (HIV), being classified as an acquired immunodeficiency syndrome-defining malignancy. The female genital tract is involved usually with non-Hodgkin lymphoma as part of disseminated disease. It is extremely rare for this tumor to originate in the female reproductive tract, especially in the endometrium. CASE: An HIV-positive woman underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy for intractable menometorrhagia and resultant anemia thought to be secondary to uterine leiomyoma. The histologic diagnosis was high-grade, immunoblastic, non-Hodgkin lymphoma with plasmacytoid features originating in the endometrium. CONCLUSION: This unusual presentation obligates the clinician to include non-Hodgkin lymphoma in the differential diagnosis when evaluating HIV-positive patients with abnormal uterine bleeding that cannot be explained after thorough evaluation.