Abstract

BackgroundWe investigated the usefulness of gasless laparoscopic surgery (GLS) using a subcutaneous abdominal wall lifting method for endometrial cancer.MethodsWe studied 105 patients with early endometrial cancer who underwent GLS (55) or open surgery (50). A uterine manipulator was used in all GLS cases. We compared operative time, blood loss, number of lymph nodes removed, hospital stay, perioperative complications, cases converted to laparotomy, and recurrence and survival rates. We also studied the learning curve and proficiency of GLS.ResultsThe GLS group had significantly longer operative time (265 vs. 191 min), reduced blood loss (184 vs. 425 mL), shorter hospital stay (9.9 vs. 17.6 days), and fewer postoperative complications (1.8 vs. 12.0%) than the open group. No case was converted to laparotomy. Disease-free and overall survival rates at 4 years postoperatively (GLS vs. open groups) were 98.0 versus 97.8 and 100 versus 95.7%, respectively, and there was no significant difference between the groups. Regarding the learning curve for GLS, two different phases were observed in approximately 10 cases. Operator 2, who was not accustomed to laparoscopic surgery, showed a significant reduction in operative time in the later phase 2.ConclusionsGLS for endometrial cancer results in less bleeding, shorter hospital stay, and fewer complications than open surgery. Recurrence and survival rates were not significantly different from those of open surgery. This technique may be introduced in a short time for operators who are skilled at open surgery but not used to laparoscopic surgery.

Highlights

  • Endometrial cancer is the second most frequent gynecologic malignancy after cervical cancer and has been on the rise recently

  • Total abdominal hysterectomy, bilateral adnexectomy, and lymph node dissection have been performed for a long time, but in recent years, Ito et al World Journal of Surgical Oncology (2021) 19:347 laparoscopic surgery has become popular due to advances in endoscopic equipment Laparoscopic surgery for endometrial cancer is less painful than open surgery and patients can be discharged earlier with less pain and fewer postoperative complications [2, 3]

  • The gasless laparoscopic surgery (GLS) group showed a significant increase in operative time (265 vs. 191 min) compared to the open group (P < 0.001), but blood loss was significantly reduced (184 vs. 425 mL; P = 0.001) and hospital stay was significantly shortened (9.4 vs. 17.6 days; P < 0.001)

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Summary

Introduction

Endometrial cancer is the second most frequent gynecologic malignancy after cervical cancer and has been on the rise recently. Total abdominal hysterectomy, bilateral adnexectomy, and lymph node dissection have been performed for a long time, but in recent years, Ito et al World Journal of Surgical Oncology (2021) 19:347 laparoscopic surgery has become popular due to advances in endoscopic equipment Laparoscopic surgery for endometrial cancer is less painful than open surgery and patients can be discharged earlier with less pain and fewer postoperative complications [2, 3]. Laparoscopic surgery requires advanced technology to perform using forceps with limited movement in the limited space of the abdominal cavity. Problems exist, such as complications and port site metastasis, caused by insufflation [5, 6]. We investigated the usefulness of gasless laparoscopic surgery (GLS) using a subcutaneous abdominal wall lifting method for endometrial cancer

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