Gynecological Oncology

Gynecological Oncology is a major focus area for Olympus providing gynecologists and patients with minimally invasive solutions.​

Sentinel Lymph Node Dissection

Sentinel Lymph Node Dissection
Different from systematic lymphadenectomy, the sentinel node biopsy offers a less radical variant for the lymph node staging in the pelvis. Sentinel node biopsy has been suggested for early-stage endometrial and cervical cancer. 1
After opening the peritoneum and developing the paravesical and pararectal spaces the sentinel node will be identified by visual inspection of the lymphatic tissue covering the iliac vessels and consequently dissected and excised.

* Legally, ICG has not been approved for intracervical injection, however the usage is widely spread and its clinical efficacy has been demonstrated in many scientific studies.

Indocyanine Green (ICG) for Sentinel Lymph Node Mapping

Evidence 2 has shown that Near Infrared (NIR) indocyanine green (ICG) yields the highest bilateral SLN detection rates (88-95.5%). 3
Its ease of use means that a reliable diagnosis can be provided along with major time savings: SLN mapping is immediate and no longer needs to be prepared in advance.

Near Infrared Imaging Benefits during Sentinel Lymph Node Dissection

The possibility to easily change from the infrared (IR) mode to conventional white light mode allows the surgeon to confidently dissect the lymph nodes without injuring the adjacent blood vessels.

Nerve-sparing Laparoscopic Hysterectomy

Safety through Advanced Hemostasis

In pelvic and para-aortic lymphadenectomy as well as in omentectomy, the surgeon works in an area of large and numerous blood vessels and nerves, but also very close to critical organs. 4 5 A safe energy device with advanced hemostasis is therefore needed — one that coagulates efficiently and ensures minimal thermal spread. 6 7 8 9 10

Reducing the Operating Time

Moreover, safe surgery for the patient means reducing the operating time as much as possible and allowing for precise dissection. THUNDERBEAT Type S combines all these demanding requirements for oncological surgeries and provides the surgeon with peace of mind. 11 12 13 14 15

THUNDERBEAT Type S Details

3D Imaging in Laparoscopic Hysterectomy

The dissection during laparoscopic hysterectomy needs to respect oncological rules and at the same time avoid accidental injuries of the vascular and lymphatic structures. Delicate and precise movements are therefore crucial. 4 5

3D vision provides the surgeon with depth perception and therefore facilitates a quicker and safer identification of the correct planes and structures.

Advantages of 3D Imaging

In this way, the movements of the surgeon are much more precise and accidental injuries can be avoided — the surgeon is able to measure the distances between anatomical structures far better. This advantage is especially beneficial:

  • In pelvic and para-aoaortic lymphadenectomy, where the high risk of hemorrhage due to a huge amount of very small vessels decreases significantly.
  • For a nerve-sparing dissection of the paravesical and pararectal spaces, which decreases the incidence of post-operative collateral effects.
  • For the preparation of the vesicovaginal space, in order to identify the correct level of dissection depth. 16 17 18 19 20 21 22 23 24 25 26

Achieving High-Quality Surgery

The laparoscopic endoscope ENDOEYE 3D* provides the surgeon with a depth perception that supports him in achieving a high-quality surgery and

  • Saves operating time.
  • Achieves improved confidence during procedures.
  • Reduces the laparoscopic learning curve.

ENDOEYE 3D Product Details

Laparoscopic Trachelectomy

Precision, Efficiency and Safety During Laparoscopy with Hybrid Technology

  • The transection of the uterine arteries at their origin, meeting the principles of radicality.
  • The dissection of the ureter, removing it from the total extension of the parametrium until its entrance into the bladder

Both surgical steps in laparoscopic trachelectomy that require a precise, fast and safe energy device. THUNDERBEAT combines all these requirements by providing the surgeon hybrid energy: Simultaneous advanced bipolar and ultrasound energy for fast cutting as well as advanced bipolar energy only for safe vessel sealing at minimal thermal spread. 11 12 13 14 15

Fine Tip for Precise Dissection

As the fine tip of the curved jaw supports the surgeon with a precise dissection, THUNDERBEAT is ideal for the dissection of the:

  • Pararectal spaces.
  • Mobilization of the rectum.
  • Rectovaginal spaces.
  • Lateral and posterior parametria at their origins.

Cervical amputation can be performed efficiently and in a blood-dry manner with THUNDERBEAT. Hybrid technology is once again the solution for a fast and safe laparoscopic procedure.

THUNDERBEAT Product Details

Simple Laparoscopic Suturing Thanks to 3D Imaging

Especially for the uterovaginal anastomosis, 3D imaging supports the surgeon during the suturing due to the depth perception. But also for the prior dissection steps, 3D imaging provides a better view of the distances between anatomical structures.

Gynecological Cancer Diagnosis with Narrow Band Imaging (NBI)

High-Resolution NBI in Gynecological Oncology

High-resolution narrow band imaging endoscopy (NBI) detection of malignomas, such as colorectal neoplasia, has been reported to improve tumor diagnosis in several medical disciplines. 27 28 29

By revealing their characteristic surface staining or vascular pattern, NBI endoscopy allows significant improvements in:

  • Tumor detection of very small lesions.
  • Occult lesions.

Before
After

Endometrial Cancer

The incidence of endometrial cancer (main type of uterine cancer) has increased
by 21% since 2008 30 31 32 33 35 .
Lymph node dissection (LND) is an important step in the surgical management of endometrial cancers. However, it contributes to complications.

Sentinel lymph node (SLN) mapping has gained increasing acceptance for staging of gynecological malignancy. Clinical evidence has shown that sentinel node mapping is an accurate and feasible method that performs well diagnostically for the assessment of lymph nodal involvement in endometrial cancer. According to clinical studies, patients who underwent SLN mapping had less pelvic/nodal recurrences compared to LND alone. Negative node patients with additional SLN mapping had superior oncological outcomes. Utilizing indocyanine green resulted in the highest SLN detection rates.

Ovarian Cancer

Ovarian cancer is the second most common malignancy after breast cancer in women over the age of 40, particularly in developed countries. 36 37 38
Thereby, for patients with clinical stageIII ovarian cancer, clinical evidence has shown that a sentinel lymph node procedure performed through the injection of tracers into the ovarian ligaments is feasible.

The overall detection rate is of 90.3%.

Cervical Cancer

Cervical cancer is the second most common malignancy of the female genital tract worldwide. Radical hysterectomy is one of the standard cervical cancer treatments for stage Ia2 to IIa cervical cancer, however it is connected with complications.

Nervesparing radical hysterectomy (NSRH) is a technique in which the neural part of the cardinal ligament remains intact. The neural part of the cardinal ligament encloses the inferior hypogastric plexus and the bladder branch (distal part of the plexus). This way, the bladder’s innervation is safe and its functional recovery is more rapid. 39 40

Associated Solutions

POWERSEAL Sealer and Divider

The true curved double-action Maryland dissector jaw results in more control and efficiency for your surgical energy experience. You can expect POWERSEAL to deliver best-in-class vessel-sealing performance, enhanced usability and many more powerful features.

VISERA ELITE III Endoscopic Visualization Platform

VISERA ELITE III is the future-proof endoscopic visualization platform with software upgrades and technology that allows you to focus on your procedures, while significantly reducing future costs.

Hybrid Technology for Laparoscopic and Open Surgery

The world's first and only advanced energy system that delivers two well-established forms of energy.

ENDOEYE 3D

The natural vision of 3D improves laparoscopic skill and allows to perform laparoscopy much more precise with 3D. Learn how the ENDOEYE 3D enables quicker learning of laparoscopic surgery and improves the quality of care as perceived by surgeons.
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Sources​

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    Impact of Indocyanine Green for Sentinel Lymph Node Mapping in Early Stage Endometrial and Cervical Cancer: Comparison with Conventional Radiotracer (99m)Tc and/or Blue Dye.         Rocha A, Domínguez AM, Lécuru F, Bourdel N.

    Buda A, Crivellaro C, Elisei F, Di Martino G, Guerra L, De Ponti E, Cuzzocrea M, Giuliani D, Sina F, Magni S, Landoni C, Milani R.     Eur J Obstet Gynecol Reprod Biol. 2016 Nov;206:213-219. doi: 10.1016/j.ejogrb.2016.09.027. Epub 2016 Sep 30. PMID: 27750179.

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