Feasibility and safety of total laparoscopic radical hysterectomy

STUDY OBJECTIVE: To evaluate feasibility and morbidity of a total laparoscopic radical hysterectomy (TLRH). DESIGN: Retrospective chart review (Canadian Task Force classification II-3). SETTING: Gynecologic cancer center. PATIENTS: Fifty-five women with cervical (39), endometrial (8), vaginal (2), or recurrent colon cancer (1), or severe pelvic endometriosis (5) followed for 3 years. INTERVENTION: TLRH in 55 women, converted to laparotomy in 3 (5.5%). MEASUREMENTS AND MAIN RESULTS: Feasibility, safety, patterns of recurrence, and survival were assessed. Estimated blood loss was 200 ml (range 50-2000 ml), median total operating time was 210 minutes, and median hospital stay was 5 days. Intraoperative complications were three vascular injuries and one obturator nerve palsy, all of which occurred in the first half of the series. Early postoperative morbidity included deep vein thrombosis, pulmonary embolism, bladder infection and dysfunction, and vaginal fistula. These events occurred less frequently in the second half of the series. Late postoperative morbidity consisted of lymphedema, pelvic abscess and lymphocyst formation, pelvic cellulitis, hyperesthesia of the leg, and small bowel obstruction. The only fatality was a patient who developed a pulmonary embolus on postoperative day 3. Median follow-up was 36.5 months. Of 39 women with cervical cancer, 34 were alive and disease free at their last visit. No case of port site metastasis occurred during follow-up. CONCLUSION: TLRH carries acceptably low morbidity that can be reduced with experience with the technique.     

Twelve-year experience with laparoscopic radical hysterectomy and pelvic lymphadenectomy in cervical cancer

Objectives

This study aims to evaluate the morbidity, oncological outcome, and prognostic factors of cervical cancer patients treated with laparoscopic radical hysterectomy and pelvic lymphadenectomy (LRH).

Methods

Patients with cervical cancer undergoing LRH at the First People's Hospital of Foshan between August 1998 and March 2010 were enrolled in this study. The medical records were reviewed.

Results

A total of 240 patients were identified. According to FIGO stage, the number of patients with stage Ia2, Ib1, Ib2, IIa, and IIb was 2, 163, 34, 35, and 6, respectively. The conversion rate was 1.25%. Intraoperative and postoperative complications occurred in 7.08% and 9.16% patients, respectively. Other medical problems included 74 cases (30%) of bladder dysfunction. Excluding the lost cases, the median follow-up of 221 cases was 35 months, and 5-year survival rate for Ia2, Ib1, Ib2, IIa was 100%, 82%, 66%, 60%, respectively. Univariate analysis showed factors impacting the survival rate were FIGO stage > Ib1, non-squamous histologic type, deep cervical stromal invasion, and lymph node metastasis (P = 0.027, 0.023, 0.007, 0.000). The Cox-proportional hazards regression analysis indicated that only lymph node metastasis (OR = 3.827, P = 0.000) was independent of poor prognostic factor. The 5-year survival rates in Ib1 were 88% with negative lymph nodes and 59% with positive lymph nodes (P = 0.000).

Conclusions

Our data demonstrate that LRH can be performed in stage Ia2-Ib1 or less advanced node negative cervical cancer patients without compromising survival. The feasibility of LRH for more advanced patients needs further investigations.     

Robot-assisted laparoscopic radical hysterectomy: comparison with total laparoscopic hysterectomy and abdominal radical hysterectomy; one surgeon's experience at the Norwegian Radium Hospital

Objectives

The purpose of this study was to investigate the 3 years follow-up results regarding the recurrence pattern of robot-assisted laparoscopic radical hysterectomies and pelvic lymphadenectomies in the early stage cervical carcinoma patients and compare the results with both total laparoscopic radical hysterectomy and abdominal radical hysterectomy groups.

Methods

A total of 68 patients underwent radical hysterectomy and pelvic lymphadenectomy for early stage cervical carcinoma management. All cases (35 robot-assisted, 7 cases laparoscopy and 26 with laparotomy) were operated by the same surgeon at the Norwegian Radium Hospital. All cases were retrospectively reviewed to compare demographics, peri-operative variables such as mean operative time, estimated blood loss, lymph node counts, complications and follow-up results.

Results

The mean operating times (skin-to-skin) for patients undergoing robot-assisted laparoscopic radical hysterectomy (RALRH), total laparoscopic radical hysterectomy (TLRH) or abdominal radical hysterectomy (ARH) were 263 ± 70, 364 ± 57 and 163 ± 26 min respectively. Patients receiving laparotomy had shortest operative time, followed by those undergoing RALRH and then laparoscopy (p < 0.0001 for both). Estimated blood loss was significantly reduced in robot-assisted surgeries compared to surgeries involving laparoscopy and laparotomy (82 ± 74 ml vs. 164 ± 131 ml (p < 0.0001) and 595 ± 284 ml (p = 0.023), respectively). The mean follow-up times were 36 ± 14.4, 56.4 ± 14 and 70 ± 21 months in patients who underwent RALRH, TLRH and ARH respectively. Until now there have been 5 recurrences and one cervical cancer related death in the robot-assisted group and no recurrences in both the laparoscopy and the laparotomy group.One patient died due to primary lung cancer in the laparoscopic group and other patient died due to primary pancreatic cancer in the laparotomy group.

Conclusions

Robot-assisted laparoscopic radical hysterectomy and pelvic lymph node dissection is feasible and more precise because the instruments provide better flexibility and 3-D vision. We must proceed cautiously, however, if a new treatment modality appears to present an increased recurrence rate. Therefore, patients submitted to robot-assisted laparoscopic radical hysterectomy should be followed carefully and RALRH would be encouraged as protocol setting until the long-term oncological outcome data are available.     

腹腔镜广泛全子宫切除加盆腔淋巴结清扫术治疗子宫恶性肿瘤安全性分析

目的探讨子宫恶性肿瘤腹腔镜广泛全子宫切除加盆腔淋巴结清扫术的安全性及并发症的防治。方法对中山大学附属佛山医院1998年8月至2006年1月行腹腔镜广泛全子宫切除加盆腔淋巴结切除术治疗95例子宫颈癌和85例子宫内膜癌的手术时间、术中出血量、淋巴结切除数目、术中及术后并发症临床资料进行回顾性分析。结果中转开腹率1.67%(3/180),手术时间(255±69)min,术中出血量(347±247)mL,淋巴结切除(20±8)个。术中膀胱损伤7例(3.89%),大血管损伤6例(3.33%)。术后并发尿潴留41例(22.78%),淋巴囊肿7例,输尿管瘘2例,膀胱阴道瘘、尿失禁、肠梗阻各1例。结论随着腹腔镜技术的不断熟练和并发症防治技巧的掌握,子宫恶性肿瘤腹腔镜下广泛全子宫切除加盆腔淋巴结切除有望成为一种极具潜力的手术方式。     

A case-controlled study of total laparoscopic radical hysterectomy with pelvic lymphadenectomy versus radical abdominal hysterectomy in a fellowship training program

To determine whether total laparoscopic radical hysterectomy (TLRH) is a feasible alternative to an abdominal radical hysterectomy (ARH) in a gynecologic oncology fellowship training program. We prospectively collected cases of all of the patients with cervical cancer treated with TLRH and pelvic lymphadenectomy by our division from 2000 to 2006. All of the patients from the TLRH group were matched 1:1 with the patients who had ARH during the same period based on stage, age, histological subtype, and nodal status. Thirty patients were treated with TLRH with a mean age of 48.3 years (range, 29-78 years). The mean pelvic lymph node count was 31 (range, 10-61) in the TLRH group versus 21.8 (range, 8-42) (P < 0.01) in the ARH group. Mean estimated blood loss was 200 cc (range, 100-600 cc) in the TLRH with no transfusions compared to 520 cc in the ARH group (P < 0.01), in which five patients required transfusions. Mean operating time was 318.5 min (range, 200-464 min) compared to 242.5 min in the ARH group (P < 0.01), and mean hospital stay was 3.8 days (range, 2-11 days) compared to 5.6 days in the ARH group (P < 0.01). All TLRH cases were completed laparoscopically. All patients in the TLRH group are disease free at the time of this report. In conclusion, it is feasible to incorporate TLRH training into the surgical curriculum of gynecologic oncology fellows without increasing perioperative morbidity. Standardization of TLRH technique and consistent guidance by experienced faculty is imperative.     

Abdominal, vaginal and total laparoscopic hysterectomy: perioperative morbidity

Purpose  

The aim of our retrospective study was to assess and to compare the surgical complications of hysterectomy regarding the choice of procedure [abdominal (AH), vaginal (VH), and total laparoscopic hysterectomy (TLH)].     

Feasibility and morbidity of total laparoscopic radical hysterectomy with or without pelvic limphadenectomy in obese women with stage I endometrial cancer

Objective  The aim of this study was to describe the feasibility and morbidity rates associated with total laparoscopic radical hysterectomy (TLRH) with or without pelvic lymphadenectomy for stage I endometrial cancer in obese women. Patients and methods  Obese patients with stage I endometrial cancer who underwent total laparoscopic radical surgery at the Department of Obstetrics and Gynecology of San Gerardo Hospital were compared to nonobese patients. The same group of obese patients was compared with patients who underwent radical laparotomic surgery. Obesity was defined as a body mass index more than 30 kg/m². Results  Between September 2003 and September 2007, 75 women underwent TLRH. Median age was 54 years and median body mass index was 28 kg/m². Thirty-seven women were obese. There were no differences between nonobese and obese women in operative, time length of parametria and pelvic nodes removed and operative or late complications. Blood loss was significantly higher in obese patients. Comparing retrospectively laparoscopy and laparotomy in obese women treated in our center, laparotomy was associated with decreased operative time, but also with increased blood loss, transfusion rate, duration of hospitalization and frequency of post surgical complications. Conclusions  Total laparoscopic radical hysterectomy (with pelvic lymphadenectomy) is a safe option in patients with endometrial cancer. Obesity is not a contraindication to perform a TRLH with no differences in surgical parameters between obese and nonobese population. TLRH show a significant decrease of complications compared to laparotomic radical surgery in obese women.     

Total laparoscopic radical hysterectomy and lymphadenectomy: the M. D. Anderson Cancer Center experience

OBJECTIVE: To retrospectively evaluate the feasibility and morbidity of total laparoscopic radical hysterectomy and lymphadenectomy. METHODS: We performed a retrospective review of all patients who underwent a total laparoscopic radical hysterectomy at our institution between May 2004 and August 2005. Data collected included age, body mass index, stage, histopathologic subtype, tumor grade, estimated blood loss, perioperative blood transfusions, number and status of lymph nodes obtained, status of surgical margins, length of hospital stay, time to resumption of normal bladder function, intraoperative and postoperative complications, and disease-free interval. RESULTS: Twenty patients underwent total laparoscopic radical hysterectomy during the study period. None of the surgeries required conversion to laparotomy. The median patient age was 41.5 years (range, 25-76). Eighteen patients had cervix cancer (5 stage IA2 and 13 stage IB1), and 2 had endometrial cancer (1 stage IB and 1 stage IIIA). Among those with cervix cancer, 12 had adenocarcinoma, 4 squamous cell carcinoma, and 2 adenosquamous carcinoma. The median weight was 70 kg (range, 49-112). The median number of resected pelvic lymph nodes was 13 (range, 9-26). One patient had nodal disease. The surgical margins were free of disease in all cases. The median blood loss was 200 ml (range, 25-700 ml). Only 1 patient required an intraoperative blood transfusion (1 U packed red blood cells). The median length of hospital stay was 1 day (range, 1-5). There were 3 short-term complications--unintentional cystotomy, pulmonary embolus, and pneumomediastinum with subcutaneous emphysema. There were 2 long-term complications--vaginal eviscerations and a lymphocyst. The median time to resumption of normal bladder function was 16 days (range, 13-29). The median follow-up time was 8 months range (1-16). All patients remain free of disease at the time of this report. CONCLUSIONS: Total laparoscopic radical hysterectomy can be performed safely with minimal blood loss and postoperative morbidity, and patients undergoing this procedure may be discharged after an overnight stay in the hospital.     

Total laparoscopic radical hysterectomy and pelvic lymphadenectomy using harmonic shears

STUDY OBJECTIVE: To describe the feasibility and outcome of total laparoscopic radical hysterectomy with or without pelvic lymphadenectomy for patients with stage I cervical cancer or severe pelvic endometriosis using harmonic shears as the sole instrument for dissection, division, and maintenance of hemostasis of all major surgical pedicles. DESIGN: Retrospective review (Canadian Task Force classification II-2). SETTING: University hospital and affiliate institutions. PATIENTS: Seven patients who underwent total laparoscopic radical hysterectomy using harmonic shears for International Federation of Gynecology and Obstetrics stage IA2 to IB1 cervical cancer and pelvic endometriosis at our institution or affiliate hospital from January 2004 through February 2005. INTERVENTION: A retrospective review of patients that underwent total laparoscopic radical hysterectomy with or without pelvic lymphadenectomy at our institution using harmonic shears was performed. Information regarding preoperative, intraoperative, and postoperative events was recorded and analyzed. MEASUREMENTS AND MAIN RESULTS: Pelvic lymphadenectomy was performed in all cancer cases. Mean patient age was 40 years (range 30-53 years). Mean estimated blood loss was 143 mL (range 100-200 mL). Mean operating time was 293 minutes (range 255-385 minutes). Mean pelvic node count was 27.8 (range 24-34) for cancer cases. Mean hospital stay was 3.2 days (range 2-7 days). One patient developed a vaginal cuff abscess postoperatively that was managed conservatively with drainage in the office setting followed by intravenous antibiotics. Another patient developed urinary retention for 2 weeks after surgery. There were no other intraoperative or postoperative complications. CONCLUSION: Total laparoscopic radical hysterectomy with pelvic lymphadenectomy using harmonic shears is a technically feasible and safe procedure. Larger studies and long-term follow-up are required to determine the oncologic outcomes of these patients.     

Laparoscopic total radical hysterectomy by the Pune technique: our experience of 248 cases

STUDY OBJECTIVE: To describe our experience and technique of total laparoscopic radical hysterectomy with pelvic lymphadenectomy, which is the largest single- institution study. DESIGN: Retrospective, nonrandomized study (Canadian Task Force classification II-2). SETTING: Private hospital. PATIENTS: Two hundred forty-eight patients with International Federation of Gynecology and Obstetrics stage IA2 (n = 32) and IB1 (n = 216) of cancer of the cervix. INTERVENTION: Total laparoscopic type III radical hysterectomy with bilateral pelvic lymphadenectomy was done. Simple repetitive steps were used to perform this surgery and develop an easily replicable technique. Harmonic Shears, bipolar coagulation, and vascular clips were used. Resection of the cardinal and uterosacral ligaments was performed with LigaSure (LigaSure Vessel Sealing System; Valleylab, Tyco Healthcare, Boulder, CO) or the Harmonic Shears (Ethicon Endo-Surgery, Inc., Cincinnati, OH). Pelvic lymph node dissection was done. MEASUREMENTS AND MAIN RESULTS: Histopathologically, there were 183 (73%) cases of squamous carcinoma, 52 (20%) adenocarcinomas, and 13 (5%) adenosquamous carcinomas. Four patients needing anterior exenteration because of bladder involvement were excluded from data analyses. The operation was performed entirely by laparoscopy in all patients and by the same surgical team. The patients' median age was 61 years. The median operative time was 92 minutes (range 65-120 minutes). The median number of resected pelvic nodes was 18. The median blood loss was 165 mL. The median length of stay was 3 days. All 15 intraoperative complications were tackled laparoscopically. No patients were converted to the open technique. There were no deaths in our series. Seventeen patients had complications within 2 months of surgery. Seven patients had recurrences after a median follow-up of 36 months. CONCLUSION: Our technique of total laparoscopic radical hysterectomy, developed over 248 cases, can be performed safely. It is an easily replicable technique. This procedure reduces the morbidity associated with abdominal radical hysterectomy. All of the complications can also be tackled laparoscopically, which does not further add to the morbidity.     

腹腔镜广泛子宫切除术及盆腹腔淋巴结切除术23例并发症分析

目的 探讨因宫颈癌及子宫内膜癌行腹腔镜广泛子宫切除术和盆腹腔淋巴结切除术患者的并发症发生情况及防治方法。方法 回顾性分析我院2000年7月至2004年12月间,278例宫颈癌及子宫内膜癌患者的腹腔镜广泛子宫切除术及盆腔、腹主动脉周围淋巴结切除术的临床资料。结果 278例腹腔镜广泛子宫切除术及盆腹腔淋巴结切除术中,除4例中转开腹外,其余手术均在腹腔镜下完成,其中有108例患者行腹主动脉周围淋巴结切除术。4例中转开腹手术者中,3例为急诊开腹手术,1例为选择性开腹手术。278例中共发生各类并发症23例,术中并发症13例,其中血管损伤7例,5例在腹腔镜下行血管修补或结扎,1例髂外静脉损伤者开腹行血管吻合术,1例开腹止血;膀胱损伤4例,均在腹腔镜下行修补术;1例患者因高碳酸血症中转开腹手术;另1例患者因结肠损伤而中转开腹行肠修补术。术后并发症10例,其中3例输尿管阴道瘘,3例膀胱阴道瘘,需再次手术治疗;1例输尿管狭窄;3例尿潴留。结论 腹腔镜广泛子宫切除术及盆腔、腹主动脉周围淋巴结切除术正在逐渐成为妇科的常规手术,其最常见的并发症是血管损伤和膀胱损伤。     

Robotically assisted laparoscopic hysterectomy versus total abdominal hysterectomy and lymphadenectomy for endometrial cancer

ObjectiveTo compare surgical morbidity and clinical–pathologic factors for patients with endometrial cancer (EC) undergoing robotic-assisted laparoscopic hysterectomy (RALH) versus total abdominal hysterectomy (TAH) with aortic and/or pelvic lymphadenectomy (LA).MethodsDuring the first 14 months of a robotics surgical program, 56 patients with EC were scheduled to undergo RALH with LA. Cases were analyzed for operative (op) time, estimated blood loss (EBL), transfusion, intra- and post-op complications, surgical–pathologic data, patient demographics and length of stay (LOS). Data was compared to 106 serially treated patients with EC who underwent TAH with LA immediately prior to initiation of our robotics program.ResultsThree robotic cases (5.4%) were converted to TAH secondary to intra-op factors. FIGO stages for RALH vs. TAH were: stage I (82 vs. 69%), stage II (7 vs. 7.5%) and stage III (11 vs. 21.5%). Patients' mean age was 59 ± 10 vs. 63 ± 11 years (p = 0.05) and body mass index (BMI) was 29 ± 6.5 vs. 34 ± 9 kg/m² (p = 0.0001) for the robotic and open groups, respectively. Severe medical co-morbidities affected 5.4% of robotic patients compared to 8.5% of open cases (p > 0.05). Comparing RALH and TAH, mean op time was 177 ± 55 vs.79 ± 17 min (p = 0.0001), EBL was 105 ± 77 vs. 241 ± 115 ml (p < 0.0001), transfusion was 0 vs. 8.5% (p = 0.005), and LOS was 1.0 ± 0.5 vs. 3.2 ± 1.0 days (p < 0.0001). Robotic patients incurred a 3.6% major peri-operative complication rate while women undergoing open procedures had an incidence of 20.8% (p = 0.007). Total lymph node count was 19 ± 13 nodes for robotic cases vs. 18 ± 10 nodes obtained from open hysterectomy patients.ConclusionsPatients with EC who underwent RALH with LA during the first year of our robotics program were younger, thinner and had less cardio-pulmonary illness than patients previously treated with TAH and LA. LOS, EBL and peri-op complication rates were significantly lower for the robotic cohort.     

Total laparoscopic radical hysterectomy (type III) and pelvic lymphadenectomy

A case of Stage IIA, G2 carcinoma of the cervix treated by total laparoscopic radical hysterectomy and pelvic lymphadenectomy is reported. To our knowledge, a total laparoscopic radical hysterectomy with laparoscopic lymphadenectomy has not been previously described in Italy.     

Laparoscopic subtotal hysterectomy versus laparoscopic total hysterectomy: a decade of experience

At present, there are only few data on the surgical outcomes of laparoscopic hysterectomy (LH). Up till now, it has been unclear whether there is a difference in number of complications among the subcategories of laparoscopic total hysterectomy and laparoscopic subtotal hysterectomy (LSH). Therefore, we have performed a retrospective analysis to evaluate the peri- and postoperative outcomes in women undergoing LSH versus LH. This multi-centre retrospective cohort study (Canadian Task Force classification II-2) was conducted in multi-centres (two teaching hospitals and one university medical centre) in the Netherlands, all experienced in minimally invasive gynaecology. In a multi-centre retrospective cohort study we compared the long-term outcomes of laparoscopic subtotal hysterectomy and laparoscopic total hysterectomy (including laparoscopic assisted vaginal hysterectomy, laparoscopic hysterectomy and total laparoscopic hysterectomy). All laparoscopic hysterectomies from the last 10 years (January 1998 till December 2007) were included. Patient characteristics, intra- and postoperative complications, operating time and duration of hospital stay were recorded. The minimum follow-up was 6 months. A total of 390 cases of laparoscopic hysterectomies were included in the analysis: 192 laparoscopic subtotal hysterectomies and 198 laparoscopic total hysterectomies. Patient characteristics such as age and parity were equal in the groups. The overall number of short-term and long-term complications was comparable in both groups: 17% and 15%. Short-term complications (bleeding, fever) were 3% in the LSH group and 12% in the LH group. Long-term complications were (tubal prolapse and cervical stump reoperations) 15% in the LSH group and 3% in the LH group. Laparoscopic subtotal hysterectomy as compared with the different types of laparoscopic total hysterectomy is associated with more long-term postoperative complications, whereas laparoscopic total hysterectomy is associated with more short-term complications.     

阴式广泛全子宫切除加腹腔镜下淋巴结切除术与开腹手术治疗早期宫颈癌疗效比较

目的探讨阴式广泛全子宫切除加腹腔镜下淋巴结切除术治疗早期宫颈癌的临床价值。方法 2004年11月至2011年4月于佛山市妇幼保健院,回顾性分析行阴式广泛全子宫切除加腹腔镜下淋巴结切除术的90例早期宫颈癌患者(阴式组)的病例资料,抽取同期行开腹广泛全子宫切除加盆腔淋巴结切除术42例(开腹组)作为对照。结果两组手术时间差异无统计学意义(P>0.05)。阴式组术中出血量[(348±114)mL]、肠道功能恢复时间[(36.76±4.9)h]、住院天数[(10.56±2.10)d]均少于开腹组的[(398±127)mL]、[(40.09±6.5)h]、[(11.79±2.45)d],差异有统计学意义(P<0.05)。阴式组切除阴道长度[(3.12±0.17)cm]大于开腹组的[(3.05±0.21)cm](P<0.05)。阴式组尿潴留发生率(30.0%)较开腹组(11.9%)高(P<0.05)。阴式组术后5年内复发率(14.6%)低于开腹组(31.5%)(P<0.05)。结论阴式广泛全子宫切除加腹腔镜下淋巴结切除术式创伤小,术后恢复快,手术彻底,有临床应用价值。     

子宫颈癌患者腹腔镜下广泛子宫切除术联合淋巴结切除术的临床效果评估

目的 评估腹腔镜下广泛子宫切除术联合盆腹腔淋巴结切除术用于治疗子宫颈癌的临床效果。方法 对57例Ⅰa～Ⅱb期的子宫颈癌患者,施行腹腔镜下广泛子宫切除术联合盆腔及腹主动脉周围淋巴结切除术。其中子宫颈鳞状细胞癌48例,腺癌7例,腺鳞癌2例。结果 除2例外,所有患者均在腹腔镜下完成手术,平均手术时间为186min(150～320min),术中平均出血168ml(120～700ml),切除盆腔和腹主动脉周围淋巴结数量平均为18．6个和8．2个;8例患者淋巴结为阳性。所有切除组织边缘大体检查均为阴性。术中2例膀胱损伤、1例静脉损伤,均于镜下修补成功;2例中转开腹。术后肛门排气时间平均为2．3d,恢复自主排尿时间平均为10．2d。手术后每3个月随访1次,发现轻度输尿管狭窄1例,尿潴留2例,阴道残端复发3例,病情未控1例。结论 腹腔镜下广泛子宫切除术联合盆腹腔淋巴结切除术j治疗子宫颈癌手术创伤小、并发症少、术后恢复快,是一种治疗子宫颈癌的理想方法。     

Laparoscopic lymphadenectomy and vaginal or laparoscopic hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer: morbidity and survival.

OBJECTIVES: Our goal was to evaluate the morbidity, recurrence, and survival of patients with clinical stage I endometrial cancer treated by laparoscopic lymphadenectomy with vaginal or laparoscopic hysterectomy and bilateral salpingo-oophorectomy.Study Design: This article is a retrospective review of records for 56 patients. The mean follow-up among those alive at last contact was 2.4 years (range, 32 days-5.2 years). Staging according to the International Federation of Gynecology and Obstetrics (1988) was as follows: I, 45 (80.4%); II, 3 (5.4%); III, 6 (10.7%); and IV, 2 (3.6%). RESULTS: Intraoperative complications occurred in 4 patients (7.1%). Transformation to laparotomy was necessary in 7 patients. Postoperative complications were observed in 9 patients (16.1%). Pelvic irradiation was administered postoperatively to 11 patients (19.6%). Among the 45 patients with surgical stage I disease, the 3-year recurrence rate was 2.5% and the 3-year cause-specific survival was 96.0%. CONCLUSIONS: Laparoscopic lymphadenectomy and vaginal or laparoscopic hysterectomy with bilateral salpingo-oophorectomy provided 3-year survival and recurrence rates similar to those of the traditional abdominal approach.     

Surgical morbidity associated with radical trachelectomy and radical hysterectomy

OBJECTIVES: To examine intra-operative, short and longer term morbidity associated with Radical Trachelectomy (RT) within our cohort of patients, compared with conventional Radical Hysterectomy (RH). METHODS: A retrospective case note review comprising 29 RT and 50 RH patients. Patients who required adjuvant treatment were excluded. Operative data, short-term and long-term complications were recorded. Long-term problems were included only if they had been of persistent nature. RESULTS: The median age and follow up period for the RH group were 40 years and 60 months and for RT group 30.5 years and 25 months. There were significant differences between RH and RT groups in median operative time (260 versus 187 min), blood loss (1000 versus 400 ml), transfusion requirement (75% versus 12%), analgesic requirement (8 versus 3.5 days) and hospital stay (11 versus 6 days). Bladder hypotonia requiring prolonged catheterisation was more frequent in RH group (P = 0.004). There was no apparent difference in psychosexual problems between the two groups (17 versus 16%). Complications of deep dyspareunia (P = 0.009), excessive vaginal discharge (P = 0.01), and upper thigh parasthesia (P = 0.05) were noted to be significantly higher in the RT group. Specific problems encountered in the RT group included; dysmenorrhea (24%), irregular menstruation (17%), recurrent candidiasis (14%), cervical suture problems (14%), isthmic stenosis (10%) and prolonged amenorrhea (7%). CONCLUSION: RT is associated with less operative and short-term morbidity compared with conventional RH. In addition to specific complications associated with RT, in our experience, there are long-term morbidities that are not as commonly observed in RH.