ReviewLaparoscopic radical hysterectomy with lymphadenectomy in patients with early cervical cancer: Our instruments and technique
Introduction
A laparoscopic radical hysterectomy with pelvic and aortic lymph node dissection was initially characterized by a longer operative time and questionable radicality, but during the past decade several reports showed the safety of this procedure [1], [2] and suggested that performing the procedure laparoscopically did not adversely affect the patient's overall prognosis and survival [3], [4], [5], [6].
Total laparoscopic radical hysterectomy (TLRH) for the management of early stage cervical cancer appeared associated with a low morbidity without compromising the degree of oncological radicality required. Laparoscopy offered to patients the potential benefits of decreased discomfort with decreased convalescence time [7], [8]. Nevertheless, few long-term data are available on the morbidity of laparoscopic radical hysterectomy and survival after this procedure [9], [10].
In this study we evaluated the technique of total laparoscopic radical hysterectomy (type III procedure) with lymphadenectomy as performed at the Advanced Gynecological Endoscopy Center of the Malzoni Medical Center, Avellino, Italy.
Section snippets
Material and methods
In our experience 77 consecutive patients (mean age 41 years, range 27–69) underwent total laparoscopic radical hysterectomy (type III) with lymphadenectomy between January 2000 and March 2008 at the Advanced Gynecological Endoscopy Center of the Malzoni Medical Center, Avellino, Italy.
FIGO stage included five patients Ia1 with LVSI (lymph-vascular involvement), 24 patients Ia2, and 48 patients Ib1. All patients involved in the study had their initial pathologic diagnosis confirmed at our
Results
All patients underwent total laparoscopic radical hysterectomy with pelvic lymphadenectomy during the study period and none of the surgeries required conversion to laparotomy.
Histological types included squamous cell carcinoma in 65 patients, adenocarcinomas in 10 patients, and adenosquamous carcinoma in two.
Para-aortic lymphadenectomy was performed up to the level of the inferior mesenteric artery in eight cases with positive pelvic lymph nodes at frozen section evaluation.
In our experience,
Discussion
During the past decade, some reports have shown the feasibility of radical hysterectomy performed entirely by laparoscopy [2], [3], but much less is known about the morbidity and mortality rates that are associated with laparoscopic radical hysterectomy (type III) with aortic and pelvic lymph node dissection and survival after this procedure [6], [7].
In a recent report, Frumovitz et al compared intra-operative, pathologic, and postoperative outcomes of 35 women who underwent total laparoscopic
Conclusion
Total laparoscopic radical hysterectomy can be considered a safe and effective therapeutic procedure for the management of early stage cervical cancer with a low morbidity and is characterized by minimal blood loss and postoperative hospitalization; moreover, the laparoscopic route may offer an alternative option for patients undergoing radical hysterectomy, although multicenter studies and long-term follow-up are required to evaluate the overall oncologic outcomes of this procedure.
Conflict of interest statement
All authors of this research paper have directly participated in the planning, execution, or analysis of this study and have read and approved the final version submitted. All authors disclose any financial and personal relationships with other people or organisations that could inappropriately influence (bias) their work. Examples of potential conflicts of interest include employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and
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