Laparoscopy-assisted vaginal hysterectomy compared with abdominal hysterectomy in clinical stage I endometrial cancer

Abstract

TO THE EDITORS: I read with great interest the paper by Kalogiannidis et al 1 and strongly support that laparoscopyassisted vaginal hysterectomy with lymphadenectomy in patients with clinical stage I endometrial cancer (EC) is a safe procedure. The highly sensitive positron emission tomography (PET) scan detects the metabolic signal of actively growing cancer cells in the body and the computed tomography (CT) scan provides a detailed picture of the internal anatomy that reveals the location, size, and shape of abnormal cancerous growths. An integrated PET/CT scan provides good anatomic and functional localization of suspicious lesions and is the better diagnostic interpreter. 2 I would like to suggest that an integrated PET/CT should be used routinely for the preoperative evaluation of the lymph node metastasis in EC. This is all the more important in the context of recent study by Lee et al 3 on ovarian preservation in low-risk EC. Surgical castration of young women induces an abrupt loss of estrogen, which causes climacteric symptoms (especially, hot flushes), sleep disorders, and long-term effects that include its deleterious impact on cardiovascular and bone health, in addition to the loss of fertility. Ovarian preservation should be performed cautiously with consideration of a patient’s age, need for fertility, and desire for preservation after being given a full explanation of the potential risks. 3 The authors performed open laparoscopy with 12-mm balloon trocar through an infraumbilical incision of 1.5-2 cm. They report 2 cases with infraumbilical hernia in laparoscopyassisted vaginal hysterectomy group. I suggest the use of direct trocar insertion with 10 mm trocar, which will reduce the chances of hernia and operative time too. Kalogiannidis et al 1 used vertical midline incision for laparotomy; however, transverse incision is better option. These incisions are 30 times stronger, are less painful, and are attrac