Robotic radical hysterectomy and pelvic lymphadenectomy for uterine rhabdomyosarcoma

Abstract

Mullerian rhabdomyosarcoma (RMS) is a rare malignancy most commonly diagnosed in childhood and adolescence. RMS of the female genital tract is often difficult to diagnose. Treatment includes chemotherapy with adjuvant surgery and/or radiation therapy reserved for persistent disease. We report a case of an 18-year-old African-American female who presented with severe menometrorrhagia, and was diagnosed with embryonal rhabdomyosarcoma of the uterus. After vincristine, dactinomycin, and cyclophosphamide failed to eradicate the central tumor, she underwent a robotic radical hysterectomy and pelvic lymphadenectomy. Mullerian rhabdomyosarcoma was once managed with multimodality therapy that often included ultraradical surgery including total pelvic exenteration. Surgical procedures that were exclusively performed via large abdominal incisions can now be completed with minimally invasive techniques. Robotic surgery can be safely and successfully applied to radical hysterectomy and lymphadenectomy for uterine rhabdomyosarcoma.

Robot-Assisted Minimally Invasive Surgery for Pediatric Solid Tumors: A Systematic Review of Feasibility and Current Status

“…35 High-definition stereoscopic optics was reported to contribute to enhanced recognition of the operative field and subsequent tissue manipulation. 17,20,22,23,27,28,31,[33][34][35][36]38,39 These remarks are supported by findings of a comprehensive bench-top experiment by Jourdan et al who established that stereoscopic vision improves task performance and accelerates the learning curve. 43 These benefits became more apparent as the complexity of simulated MIS tasks increased.…”

“…Neoadjuvant chemotherapy was reported as part of the treatment strategy in three cases. 17,23,27 There were no reports of positive microscopic tumor margins. Although length of follow-up differed con-siderably amongst studies (range 2-72 months), no local tumor recurrence or port-site metastases were recognized.…”

“…17,20 Almost universally, authors commented that the dexterity of seven degree-of-freedom articulated instruments, along with intuitive master-slave control permitted more meticulous dissection during tumor extirpation. 17,20,22,23,27,28,31,[33][34][35][36]38,39 Tremor filtration and motion scaling capability were also noted to facilitate greater instrument control and precision. 20,28,34 When intracorporeal suturing was required, this was considered an easier and quicker task to perform.…”

“…This has obvious ergonomic benefits, particularly for longer cases in which fatigue might compromise operative performance. 20,23…”

“…Backes et al considered MIS to be a preferable treatment option, but concern for compromise in surgical and oncological principles guided their decision to use robot assistance. 23 As contributor of over 50% of the cases identified in this review, Meehan and Sandler were able to undertake many cases that they had not yet performed using conventional MIS. 19 Surgical complication rates for abdominal tumor surgery in general are reported to be as high as 30%, 44 and conversion rates for solid tumor resection using conventional MIS range from 21 16 to 23 13 to 56% 7 in the pediatric literature.…”