Die laparoskopisch assistierte vaginale Radikaloperation LAVRO des Zervixkarzinoms - Perioperative Parameter und Komplikationsraten

Abstract

Presently we note a standardization of techniques for laparoscopy assisted radical vaginal hysterectomy (LARVH). Altgassen et al. pointed to this fact with their evaluation of 108 operations for cervical cancer. They considered the necessity to perform 100 such operations before standardizing this method. In our survey we compare a similar number of operations performed in our department in order to prove whether Altgassen's thesis is correct, taking peri- and postoperative parameters as well as complications into consideration. For this purpose we analyzed the number of operations necessary to develop and standardize laparoscopic pelvic lymphadenectomy combined with radical vaginal hysterectomy in women treated for cervical cancer. Between 1st August 1993 and 31st January 1999, 80 patients with cervical cancer FIGO stage Ia2-IIb were selected for laparoscopy assisted radical vaginal hysterectomy. We were able to perform this operation in 71 patients. The operation reports and records of the postoperative period were evaluated retrospectively. The average duration of the operation increased from 380 minutes in cervix carcinoma Ia2 to 530 minutes in cervix carcinoma IIb. The average blood loss remained the same at 1,000 ml for each operation. Correspondingly the average decrease of hemoglobin was 3.5% for all operations. The number of pelvic lymph nodes removed unilaterally varied between 6 and 13. If the group of 37 patients with cervical cancer FIGO stage Ib--particularly homogenous as far as the spread of the tumor and the course of the operation are concerned--is divided up into one group up to the 50th operation and another group after the 50th operation, the regression analysis after the 50th operation shows a statistically significantly higher number of lymphnodes (11 compared to 25; Mann-Whitney-U-Test, p = 0.00014). However no differences were found for mean blood loss (800 ml compared to 700 ml) or duration of operation (400 minutes compared to 420) (Mann-Whitney-U-Test, p > 0.05). 5% of serious complications were associated with the laparoscopic part of the procedure--a blood vessel lesion, a ureter lesion, two postoperative intraperitoneal secondary hemorrhages. 7.5% serious complications in the area of the bladder and the ureter were associated with the vaginal part of the procedure. In 6% of our procedures we observed lymphedema in the lower extremities. Deep Compartment Syndrome was observed in 5% of our patients and associated with the duration of the procedure. To implement and standardize our technique of laparoscopic pelvic lymphadenectomy and radical vaginal hysterectomy a learning phase of 50 procedures was necessary.