SUMMARY
I have had a basic laparoscopy skill during my residencyin the Department of Obstetrics and GynecologyUniversity of Indonesia back in 1974. At thattime this procedure only for diagnostic purpose especiallyto determine the patency of the fallopian tube.Time goes on and laparoscopy now becomes verypopular surgical procedure as a minimal invasive surgeryin almost all of the surgical procedure not onlyin gynecologic field but also has expanded to digestivesurgery, orthopedic, ENT, thorax surgery. Prof.Joo-Hyun Nam, MD (Prof. Nam) from Korea suggestedme to develop this kind of surgery. Gynecologiconcologist should have competency for doingthis minimal invasive surgery such radical surgery incervical cancer, endometrium and early ovarian canceror just for surgical staging includes paraaorticlymphadenectomy and omentectomy.Before I involved deeply in laparascopic gynecologiconcology surgery, I have learned much formdr. Wachyu Hadisaputra, as the chairman of the gynecologicendoscopy working group from POGI (IndonesianSociety of Obstetrician and Gynecology), inlaparoscopic gynecologic non oncology surgery.In late 1990 I attended a symposium Laparoscopyin Gynecologic Oncology in Philadelphia organizedby the late Prof. Dargent under IGCS (InternationalGynecology Cancer Society). In 2005 I followed aworkshop for radical hysterectomy and lymphadenectomyon unbalmed cadaver (fresh cadaver) in Floridaduring Annual Meeting Society of Gynecologic Oncology,and I joined for the next year workshop. Thetrainer came from prominent countries such as USA,Germany and France. Since then I practiced total hysterectomywith laparoscopic surgery, even in smallnumber of cases. In early 2009 I had an opportunityto visit Prof. Nam hospital in Seoul and watched himdoing live radical surgery in the operating theatre. Inthe same year I practiced paraaortic lymphadenectomyon swine in Shanghai. Back from Seoul I anddr Chamim started doing radical surgery at FatmawatiHospital and months later I followed an unbalmed cadaverLaparoscopic Symposium in Oncology inTaichung Taiwan. Another case done at Omni Hospitalto fullfil dr. Boy Busmar’s invitation.From what I had been experienced I can suggestthat we have set a solid team which is very importantand supported by good equipment such colpotomy device,bipolar dissection, scissor, hormonic and ligaclipare very helpful if possible but if is available enoughwith bipolar dissection. The first step to assess theinternal genital, if there is a massive adhesion itwould prolong the surgery time.We then opened or incised the peritoneum betweenround ligamentum and fimbria and extended mediallyand laterally to exposed psoas muscle and ureterwhich cross the common iliac artery. The round ligamentshould stay intact to ease the surgery and preventthe uterus not to distort. Vesico-uterine fold wasopened and we made a space such as paravesical andpararectal spaces. Then the procedure was done mediallyto extract fat and node ventral to common iliacuntil the wall of the artery was noted and we did lymphadenectomyalong the external iliac artery. By doingthis procedure, the iliac vein, internal iliac anduterine artery will be exposed and obturator nerve aswell. The nodes was then put in the plastic bag madeof plastic drug so it is very cheap instead of specialbag sold by the supplier. Ureter was disected andpushed aside and ureteric canal was opened.Vagina was amputated by direction of colpotomy deviceand top of the vagina sutured through the vaginaas suggested by Prof. Nam. By doing this if we thinkthat vagina cut was inadequate, we can cut it more.The beginning of the procedure took more than 4hours and as mentioned by the literatures that thelearning curve will decrease by the amount of surgery.We have done 5 cases, 1 of those with serosal lacerationof the sigmoid and repaired the lacerated serosalwith few stitches and 1 case with iliac vein and thebleeding could be controlled using ligaclip. I hopethat this minimal invasive surgery will enrich our modalityin handling the malignancy in gynecologic surgeryand we can positioned to the level of developedcountries in Asia.The Asian Society of Gynecologic Oncology hasplanned to train Young Gynecologic Oncologist inthis kind of surgery. In July 2010 there will be aworkshop laparoscopy in gynecologic Oncology inSeoul and Indonesian Society of Gynecologic Oncology(Himpunan Onkologi Ginekologi Indonesia) isasked to propose candidates. Accommodation andtransportation while in Korea will be covered byASGO. I hope, this invitation can be responded wellby our young gynecologic oncologist.