<![CDATA[I have had a basic laparoscopy skill during my residency
in the Department of Obstetrics and Gynecology
University of Indonesia back in 1974. At that
time this procedure only for diagnostic purpose especially
to determine the patency of the fallopian tube.
Time goes on and laparoscopy now becomes very
popular surgical procedure as a minimal invasive surgery
in almost all of the surgical procedure not only
in gynecologic field but also has expanded to digestive
surgery, orthopedic, ENT, thorax surgery. Prof.
Joo-Hyun Nam, MD (Prof. Nam) from Korea suggested
me to develop this kind of surgery. Gynecologic
oncologist should have competency for doing
this minimal invasive surgery such radical surgery in
cervical cancer, endometrium and early ovarian cancer
or just for surgical staging includes paraaortic
lymphadenectomy and omentectomy.
Before I involved deeply in laparascopic gynecologic
oncology surgery, I have learned much form
dr. Wachyu Hadisaputra, as the chairman of the gynecologic
endoscopy working group from POGI (Indonesian
Society of Obstetrician and Gynecology), in
laparoscopic gynecologic non oncology surgery.
In late 1990 I attended a symposium Laparoscopy
in Gynecologic Oncology in Philadelphia organized
by the late Prof. Dargent under IGCS (International
Gynecology Cancer Society). In 2005 I followed a
workshop for radical hysterectomy and lymphadenectomy
on unbalmed cadaver (fresh cadaver) in Florida
during Annual Meeting Society of Gynecologic Oncology,
and I joined for the next year workshop. The
trainer came from prominent countries such as USA,
Germany and France. Since then I practiced total hysterectomy
with laparoscopic surgery, even in small
number of cases. In early 2009 I had an opportunity
to visit Prof. Nam hospital in Seoul and watched him
doing live radical surgery in the operating theatre. In
the same year I practiced paraaortic lymphadenectomy
on swine in Shanghai. Back from Seoul I and
dr Chamim started doing radical surgery at Fatmawati
Hospital and months later I followed an unbalmed cadaver
Laparoscopic Symposium in Oncology in
Taichung Taiwan. Another case done at Omni Hospital
to fullfil dr. Boy Busmarâs invitation.
From what I had been experienced I can suggest
that we have set a solid team which is very important
and supported by good equipment such colpotomy device,
bipolar dissection, scissor, hormonic and ligaclip
are very helpful if possible but if is available enough
with bipolar dissection. The first step to assess the
internal genital, if there is a massive adhesion it
would prolong the surgery time.
We then opened or incised the peritoneum between
round ligamentum and fimbria and extended medially
and laterally to exposed psoas muscle and ureter
which cross the common iliac artery. The round ligament
should stay intact to ease the surgery and prevent
the uterus not to distort. Vesico-uterine fold was
opened and we made a space such as paravesical and
pararectal spaces. Then the procedure was done medially
to extract fat and node ventral to common iliac
until the wall of the artery was noted and we did lymphadenectomy
along the external iliac artery. By doing
this procedure, the iliac vein, internal iliac and
uterine artery will be exposed and obturator nerve as
well. The nodes was then put in the plastic bag made
of plastic drug so it is very cheap instead of special
bag sold by the supplier. Ureter was disected and
pushed aside and ureteric canal was opened.
Vagina was amputated by direction of colpotomy device
and top of the vagina sutured through the vagina
as suggested by Prof. Nam. By doing this if we think
that vagina cut was inadequate, we can cut it more.
The beginning of the procedure took more than 4
hours and as mentioned by the literatures that the
learning curve will decrease by the amount of surgery.
We have done 5 cases, 1 of those with serosal laceration
of the sigmoid and repaired the lacerated serosal
with few stitches and 1 case with iliac vein and the
bleeding could be controlled using ligaclip. I hope
that this minimal invasive surgery will enrich our modality
in handling the malignancy in gynecologic surgery
and we can positioned to the level of developed
countries in Asia.
The Asian Society of Gynecologic Oncology has
planned to train Young Gynecologic Oncologist in
this kind of surgery. In July 2010 there will be a
workshop laparoscopy in gynecologic Oncology in
Seoul and Indonesian Society of Gynecologic Oncology
(Himpunan Onkologi Ginekologi Indonesia) is
asked to propose candidates. Accommodation and
transportation while in Korea will be covered by
ASGO. I hope, this invitation can be responded well
by our young gynecologic oncologist.]]>
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