“No-gas” laparoscopy, when it is needed by the overweight woman with cancer

“No-gas” laparoscopy, when it is needed by the overweight woman with cancer

Laparoscopy is the preferred surgical option for the treatment of women with gynecological cancers. How the gas-less technique works

It is technically called "gas-less". It is the technique that involves carrying out through tubes that are introduced into the abdomen, but without the need to introduce carbon dioxide into the belly to dilate the viscera. And it can also prove extremely useful in the case of highly overweight or obese women: this method of intervention, in the case of gynecological tumors, can reduce the risks related to the classic intervention.

How you do it

The intervention is described by Antonino Ditto, oncologist of the Gynecological Oncology Unit of the National Cancer Institute of Milan "Special needles are introduced on the sides of the abdomen, in the subcutis, which allow to lift the fat without traumatizing the tissues ”- explains the expert. In this way the surgical maneuvering space is obtained without the need for carbon dioxide, or by introducing a minimum quantity of it which is not dangerous for the patient. Previous studies have not shown significant differences with respect to traditional laparoscopy, in terms of complications, morbidity and aesthetic result ".

To date, laparoscopy is – together with robotic surgery – the preferred surgical option for the treatment of women with gynecological malignancies and in particular for early stage endometrial cancer. However, not all patients are eligible for this approach. In the case of obesity, in fact, women are more easily directed towards traditional surgery, with all the disadvantages that it brings with it: greater trauma to the abdominal wall, longer recovery times, an aesthetic disadvantageous surgical incision against the micro-incisions of laparoscopy.

In some cases, patients with morbid obesity are also judged inoperable for non-surgical reasons such as the high anesthetic risks and are directed to oncological treatments such as chemotherapy, hormone therapy or radiotherapy with significantly lower possibilities of cure.

"Laparoscopy involves the insufflation of carbon dioxide into the abdominal cavity, which allows a detailed view of the area – continues Ditto. The presence of gas in the abdomen, however, can cause physiological reactions such as an increase in heart rate and venous return, which are normally well compensated in a healthy body, but potentially dangerous in patients with concomitant diseases, as frequently happens in those who is obese. Not only. To make the surgeon's work easier, the patient is supine and slightly inclined downwards on the head. This position causes obese women to shift fat towards the chest which causes difficulty in breathing and risks for the heart ”.

A study to evaluate its benefits

On this issue, of course, there is a need for clear scientific evidence. This is why a tailor-made clinical study is about to start at the National Cancer Institute in Milan. "The aim is to confirm the validity of this life-saving solution, involving women with a body mass index (BMI) greater than 35, ie obese and large obese diagnosed with endometrial cancer – emphasizes Ditto".

It should be remembered that, in general terms, obesity represents an important problem in oncology and, in particular, in the field of gynecological oncology. This condition may be correlated with premenopausal cervical and ovarian cancer and is now responsible for four out of ten endometrial cancers. The risk of this form of cancer in obese and severely obese women is five times higher than in women of normal weight.

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