The Foundation’s outreach program includes an educational series of lectures developed for house staff and practicing physicians. Each teaching module includes discrete lectures and interactive slideshows focusing on a range of topics in women’s health care. The lectures prepared and delivered during the current outreach program in Cambodia included “The Management of Uterine Tumors and Abnormal Bleeding,” “Pap Testing and Cervical Cancer Screening,” and “The Management of Ovarian Cysts and malignant tumors.” These lectures are available online as a subsequent upload. Through the educational initiative of the Women’s Cancer Care Foundation we hope to impact women’s health care services by developing the infrastructure of local professional healthcare delivery. Enabling the local provider community to elevate their proficiency in the areas of cancer screening and treatment will help improve the outcome of the local residents while helping to better preserve the limited resources available for patients with more intensive care needs.The Women’s Cancer Care Foundation 2011 Outreach Program brought TeamCirisano to Cambodia for the delivery of medical and surgical services to over 200 patients. This included gynecologic exams, cancer screening, and surgical tumor removal for 15 selected cases. Additionally, the Foundation sponsored the TeamCirisano Outreach Lectureship Series.
The role for robotic surgery includes the laparoscopic hysterectomy procedure for uterine myomata also known as fibroid tumors. Depicted here is the procedure which may be indexed to consist of 3 primary steps that secure blood supply within vascular pedicles. Additionally, 3 ancillary or secondary steps must be completed which allow development of spaces that usually are less vascular ( avascular ). Once all six steps are completed, the specimen may be delivered via the vaginal incision also termed a colpotomy incision. The primary steps consist of division of the ovarian artery ( right and left ), the uterine artery ( right and left ), and the blood supply to the vaginal apex ( anterior and posterior ). The secondary steps consist of division of the round ligaments ( right and left ), the uterosacral ligaments ( right and left ), and development of the bladder flap also called the vesicovaginal space. Following delivery of the specimens, the vaginal incision is closed with two stitches using robotic assisted wristed instruments.
The robotic laparoscopy da vinci si system can be used in the management of early stage uterine cancer, benign gynecologic tumors or conditions, and in the management of early stage ovarian and cervical cancer. This allows the patient to avoid the need for a classical abdominal wall inscision. Laparoscopy may be performed using an 8 mm inscision in the belly button using the da vinci robotic system. This allows the surgery to be completed in under 90 minutes, and patients may often be discharged the same day ( outpatient ). Though not all patients are candidates, most may be considered for this surgical approach and evaluated preoperatively for this newer technology. When utilized, the robotic da vinci laparoscopy system is ‘docked’ to the patient prior to initiation of surgery, and is depicted here, requiring approximately 5 minutes to setup the system for use.
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The management of ovarian cancer has been previously premised upon advanced stages of disease at diagnosis. Typically, ovarian cancer is diagnosed at stages III and IV, when the tumor has already demonstrated spread beyond the primary site of origin within the ovarian capsule or skin ( epithelium ). Initial management generally included radical surgery to both remove all areas of visible tumor, and identify locations of spread for the purpose of directing additional treatment. The surgery is considered the first step in treatment for these advanced stages, and is usually followed by combination chemotherapy, meaning more than one drug, administered in 4-6 hour sessions at intervals of 3-4 weeks. The total number of treatments following initial surgical removal of the tumor is typically 6 cycles, and the total number of months under treatment approximates 5 months. The most remarkable impact on outcome has included higher survival rates with surgery followed by chemotherapy. The majority of patients treated with optimal surgical tumor removal and chemotherapy will achieve remission, defined as no detectable cancer cells remaining. This definition of remission is generally distinguished from cure, which is defined as a remission that lasts for 5 years or more. Additionally, the proportion of patients living well beyond 5 years despite treatment for recurrent disease has increased significantly with ongoing advances therapy options.