Versatility of Gelpoint laparoscopy access device (GLAD) as a minimally invasive approach for various gynecologic oncology procedures

s 449 Versatility of Gelpoint laparoscopy access device (GLAD) as a minimally invasive approach for various gynecologic oncology procedures E. Chapman-Davis, J. Schink, D. Singh, B. Buttin, J.R. Lurain, M.P. Lowe Northwestern University Feinberg School of Medicine, Chicago, IL, USA Objective: Minimally invasive approaches for gynecologic malignancies have primarily focused on initial staging procedures for uterine and cervical cancer. Few minimally invasive strategies exist for the management of large adnexal masses, endometrial cancer with an enlarged uterus, and ovarian cancer. The purpose of our study was to determine the utility of a Gelpoint laparoscopy access device in conjunction with minimally invasive approaches for diagnosis and treatment of gynecologic diseases. Methods: We prospectively followed all gynecologic oncology surgical cases performed using a Gelpoint access device in conjunction with laparoscopy or robotics over 1 year (March 2010–March 2011). Demographics, preoperative indications, tumor size, postoperative outcomes, feasibility and complications were analyzed. Results: A total of 29 patients underwent a minimally invasive approach using the Gelpoint laparoscopy access device over the study period. The average agewas 50 years (range 27–85), and average BMI—26 (range 18– 40). Preoperative indications for use included adnexal mass (n=20), enlarged uterus (n=3), restaging procedures for ovarian cancer (n=4), and endometrial cancer (n=2). An elevated CA 125 was detected in 56% (13/23) (range 34–1547). The average initial incision size for a Gelpoint access device was 5.2 cm (range 3 cm–8 cm). Single port surgery was performed in 20% (5/29) and one additional port used in 21% (6/29) of patients. The average number of ports used was 2.9 (range 1–5). There was a 0% conversion rate to formal laparotomy. 14 patients underwent laparoscopic surgery and 15 patients underwent robotic surgery utilizing the Gelpoint access device. Of the 20 patients with adnexal masses, the average tumor sizewas 11.25 cm, (range 5 cm–40 cm;>10 cmn=9pts). 85% (17/20) of adnexal masses were benign (mucinous n=3, serous n=1, dermoid n=3, endometrioma n=3, fibroma n=5, hemorrhagic cyst n=1, struma ovarii n=1) and 15% (3/20)was borderline at the time of frozen section and subsequently underwent routine staging. 100% of masseswereable tobe removed throughaGelpoint accessdevicewithout enlarging initial incision, or intraoperative spillage. 30% (6/20) of patients required controlled drainage for removal. 2/3 patients with enlarged uterus hadendometrial cancer,1 hadhyperplasia, and all had fibroids. The average uterine weight was 365 g. 67% (4/6) of patients who underwent restaging procedures had chemotherapy prior to interval surgery (Stage III/IV ovary n=2 Stage IV/recurrent uterine cancer n=2). 33% (2/6)with ovarian cancer underwent upfront formal staging. Utilizing the Gelpoint access device with laparoscopy or robotics was associated with a short hospital stay, minimal EBL, and rare complications. Conclusion: The Gelpoint access device used with laparoscopy/robotics is a safe and feasible alternative to traditional laparotomy for treatment of large adnexal masses, endometrial cancer within an enlarged uterus, and for specific restaging procedures. The device facilitates multiquadrant minimally invasive surgery via small incisions, with few complications, minimal blood loss, and short hospital stay. doi:10.1016/j.ygyno.2011.07.090 Challenging prognostic factors for chemotherapy resistance in high-risk gestational trophoblastic neoplasia B. Davidson, C. Nagel, M. King, T. Skorpinski, S. Kehoe, D. Richardson, D. Miller, J. Lea University of Texas Southwestern Medical Center, Dallas, TX, USA Objective: Gestational trophoblastic neoplasia is one of the most curable gynecologic tumors. Patients with WHO scores equal to or greater than 7 are considered high risk and treated with multi-agent chemotherapy. Certain risk factors, such as stage IV disease and a WHO score of greater than or equal to 12 have been identified as predisposing patients to chemotherapy resistance. Our objective was to review the characteristics of patients treated for high-risk gestational trophoblastic neoplasia (GTN) at our institution. Methods: This is a retrospective review of patients diagnosed with high risk GTN based on the revised WHO scoring system from 1999 to 2010. Descriptive statistics were performed using Microsoft Excel 2011 and Instat was used to perform Fisher's exact test. Results: Seventeen women were identified as having been treated for high risk GTN. The mean age was 28 years (range 15–48) and the mean WHO score was 10 (range 7–19). All patients were initially treated with EMA-CO and received an average of 7 cycles (range 5– 12). Three patients presented with symptomatic brain metastases and underwent surgical resection prior to the initiation of chemotherapy. Seven patients underwent hysterectomy during the course of their initial treatment. Two of the 17 patients treated for high risk GTN were diagnosed with persistent disease and 1 was diagnosed with a recurrence. EMA-EP was used to treat two of these patients and TPTE was used to treat the third. None of the patients with brain metastases had persistent/recurrent disease. No patients died of disease. Neither WHO score≥12 (p=1.0) or stage IV disease (p=1.0) were significant prognostic factors for recurrence or persistence. All other WHO risk factors also did not predict patients at risk for disease recurrence or persistence. Conclusion: High risk gestational trophoblastic neoplasia continues to have an excellent prognosis. Standard WHO risk factors and previously identified prognostic indicators such as stage IV disease and a WHO score greater than or equal to 12 do not correlate with disease recurrence or persistence. doi:10.1016/j.ygyno.2011.07.091 Evaluating operative times for dual-console robotic gynecology procedures at a single institution: A review of our first fifty cases A. Smith, E. Scott, T. Krivak, S. Richard University of Pittsburgh Medical Center, Magee Women's Hospital, USA Objective: Robotic surgery has emerged as an alternative option in minimally invasive gynecologic surgery. As technology continues to advance, the advent of the dual-console da Vinci Si Surgical System has allowed for furthermodifications in the training atmosphere.We sought to investigate operative times and estimated blood loss while operating with the dual-consolemodel in a training environment for our first fifty cases. Methods: We retrospectively identified the first fifty patients who underwent robotic-assisted total laparoscopic hysterectomy (TRH), with orwithout bilateral salpingo-oophorectomy(BSO),withorwithout pelvic and para-aortic lymph node dissection (PPALND) using the dual-console da Vinci Si Surgical System at a single institution. Records were reviewed for patients' age, body mass index, pre-operative diagnosis, procedure, complications, estimated blood loss, and total surgery time. All surgeries were conducted using the dual-console system and were performed by staff physicians and fellows. Operative time was calculated from robotic docking until the completion of the procedure. Indications for