History Gynecologic And General Surgery Literature

Vertical midline laparotomy is argued as the gold standard for ovarian malignancy, because large prospective randomized clinical trials comparing laparoscopy are absent from the contemporary gynecologic literature (13). Despite this argument, the ubiquity and benefits of laparoscopy has driven minimally invasive management for many gynecologic malignancies (14). Using laparoscopy for the treatment of uterine carcinoma with bulky adenopathy appears to have a higher gynecologic risk of port site recurrence when compared to open surgery (15-18). Additional citations also reflect that nearly every gynecologic malignancy has reported port site recurrences (19-21).

In evaluating the cases reported regarding port site seeding, several common elements emerge. Many cases are associated with circumstances where malignancy was unexpected or was being determined with diagnostic laparoscopy or biopsy (10,22). As such, basic principles of cancer surgery may have been violated and in many cases metastatic disease (i.e., carcinomatosis) or malignant ascites was already present (23). In addition, the majority of cases involved removal of tissue either directly through a trocar site or through a small incision without entrapment sac protection.

A careful search of the urologic literature demonstrates a relatively low incidence of laparoscopic port site seeding from adrenal, renal, urothelial, testicu-lar, or prostate carcinomas.

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