Two-port access for laparoscopic surgery for endometrial cancer using conventional laparoscopic instruments

Kuan-Ju Huang,Wen-Chun Chang,Ying-Xuan Li,Bor-Ching Sheu

doi:10.1038/s41598-020-79886-8

Abstract

Minimally invasive surgery is the first-line management for endometrial cancer. The role of 2-port access laparoscopy (TPA) has been underestimated. Compared to conventional laparoscopic surgery (CL), TPA is associated with smaller total incision size and less postoperative pain. Compared to single-incision laparoscopic surgery, no specific instruments and surgical techniques are needed. This study primarily evaluated the surgical and pathologic outcomes of TPA with conventional instruments, and additionally evaluated the surgeon’s learning curve. Consecutive patients who underwent TPA and CL for endometrial cancer between 2015 and 2019 were included. Baseline characteristics were recorded. In total, 148 patients (TPA, 89; CL, 59) were identified. The baseline characteristics were similar, except for a greater proportion of patients in the CL group receiving para-aortic lymph node dissection (5.62% vs. 35.59%, P < 0.01). The mean operation time was significantly less in the TPA group (152.09 vs. 187.15 min; P < 0.01). Both the groups had comparable 5-year progression-free survival (TPA, 86.68%) and 5-year overall survival rates (TPA, 93.24%). Analysis of the learning curve showed that the operation time decreased after 3–4 procedures. TPA using conventional laparoscopic instruments for endometrial cancer is feasible and is easily accessible to patients and surgeons.

Highlights

Invasive surgery is the first-line management for endometrial cancer
The limitations and challenges with Single-incision laparoscopic surgery (SILS), such as triangulation, instrument collision, and perspectives in surgical field, in lymph node sampling, can render the technique challenging to surgeons and increase the operation time, which in turn poses a threat to patients because of prolonged anesthesia, a steep Trendelenburg position, and pneumoperitoneum[9,10,11]
Washing cytology (TPA vs. conventional laparoscopic surgery (CL), 100% vs. 93.22%; P = 0.01) and pelvic adhesion (TPA vs. CL, 30.34% vs. 15.25%; P = 0.04) were performed more often in the The role of 2-port access laparoscopy (TPA) group, whereas Para-aortic lymph node dissection (PALND) was performed more often the in CL group (TPA vs. CL, 5.62% vs. 35.59%, P < 0.01)

Summary

Introduction

Invasive surgery is the first-line management for endometrial cancer. Compared to conventional laparoscopic surgery (CL), TPA is associated with smaller total incision size and less postoperative pain. TPA using conventional laparoscopic instruments for endometrial cancer is feasible and is accessible to patients and surgeons. The limitations and challenges with SILS, such as triangulation, instrument collision, and perspectives in surgical field, in lymph node sampling, can render the technique challenging to surgeons and increase the operation time, which in turn poses a threat to patients because of prolonged anesthesia, a steep Trendelenburg position, and pneumoperitoneum[9,10,11]. We evaluated the surgical outcomes and cost for patients undergoing 2-port access (TPA) procedures using CL instruments for EC. We evaluated the learning curve associated with this technique over an expanded sample size

Methods

Results

Conclusion