Transvaginal Laparoscopy for Management of Low-Grade Endometrial Cancer

Abstract

Study Objective to report on our experience with transvaginal laparoscopic management of low-grade endometrial cancer. Design a study of transvaginal natural orifice endoscopy to manage patients with grade 1 or grade 2 endometrial cancer. This is descriptive of the surgical findings and consequences. Setting a single institution academic center Patients or Participants 32 women with low-grade endometrial cancer were consented for hysterectomy, bilateral salpingo-oophorectomy (BSO) by a transvaginal approach utilizing laparoscopy. Interventions Anterior and Posterior cul-de-sacs were opened through the vagina. A gel point device was placed into these spaces, the patients reclined in slight Trendelenburg position, and the abdomen insufflated. A vessel sealing device was used under laparoscopic visualization to cauterize and cut the paracervical tissue, uterosacral ligaments, uterine vasculature, broad ligament and utero-ovarian pedicle. The uterus was removed and submitted to pathology for depth of invasion. The tubes and ovaries were then removed laparoscopically and the entire abdominal cavity was inspected. Patients with deep invasion underwent trans-abdominal laparoscopic lymphadenectomy. Measurements and Main Results a total of 32 women underwent the procedure. The mean age was 60(26 – 90). The mean BMI was 34(22 – 58). 19 had prior pelvic surgery including eight with one or more prior cesarean deliveries. The mean uterine weight was 119 g (27 – 436). 12 patients were discharged home that day and 20 stayed overnight. One patient had a thermal injury to the small bowel requiring over sewing. Two patients had bladder injury during entry to the Anterior cul-de-sac, both of whom had had two prior cesarean deliveries. One patient required lymphadenectomy. Patients did not require narcotic analgesia. Conclusion transvaginal laparoscopic hysterectomy, BSO is feasible and permits rapid recovery with minimal postoperative pain and is cosmetically appealing.