Complications of laparoscopic radical hysterectomy and lymphadenectomy for invasive cervical cancer: experience based on 317 procedures |
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Authors: | H Xu Y Chen Y Li Q Zhang D Wang Z Liang |
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Institution: | (1) Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University, 30 Gao Tanyan Main Street, Chongqing, 400038, P. R. China |
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Abstract: | Background This report presents the incidence of complications and conversions during laparoscopic radical hysterectomy and lymphadenectomy
performed for invasive cervical carcinoma. The data are analyzed, and strategies to help prevent future complications are
discussed.
Methods From July 2000 to December 2005 at the authors’ institution, 317 laparoscopic radical hysterectomy and lymphadenectomy procedures
for invasive cervical carcinoma were performed. The authors reviewed the database of patients who underwent laparoscopic radical
hysterectomy and lymphadenectomy to examine complications and analyze factors associated with conversion to an open surgical
procedure.
Results All but four surgical procedures were laparoscopically completed. Pelvic lymphadenectomy was performed for all the remaining
313 patients, 143 of whom underwent paraaortic lymphadenectomy. Major and minor intraoperative complications occurred for
4.4% (n = 14) of the patients. The overall conversion rate was 1.3% (n = 4), including 3 emergencies and 1 elective conversion. Seven patients had vessel injuries, five of which were repaired
or treated laparoscopically. One left external iliac vein required laparotomy, and one patient underwent laparotomy to control
bleeding sites. Operative cystotomies occurred in five patients, which were repaired laparoscopically. Two patients underwent
laparotomy because of hypercapnia and ascending colon injury. Postoperative surgery complications occurred in 5.1% (n = 16) of the patients, including 5 patients with ureterovaginal fistula, 4 with vesicovaginal fistula requiring reoperation,
1 with ureterostenosis treated by placement of a double-J ureteral stent, and 6 with bladder dysfunctions (retention) that
exhibited complete resolution within 3 to 6 months by intermittent training and catheterization.
Conclusions Laparoscopic radical hysterectomy and lymphadenectomy is becoming a routine procedure in the armamentarium of many gynecologists.
Complications unique to laparoscopy do exist, but they decrease with repeated training of the procedure and gradually enriched
experiences. |
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Keywords: | Cervical carcinoma Complication Laparoscopic radical hysterectomy Lymphadenectomy |
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