Laparoscopic Radical Hysterectomy Research Articles

Effects of perioperative oxycodone as the sole opioid on immunity within a multi-modal analgesia framework in patients undergoing cervical cancer surgery: A randomised controlled trial

Background and Aims: Current views on oxycodone’s effects on immunity are inconsistent. Our objective was to compare the effects of perioperative oxycodone as the sole opioid in a multi-modal analgesia regimen with conventional opioid regimens on immunity in cervical cancer. Methods: In this randomised controlled trial (RCT), patients scheduled for laparoscopic radical hysterectomy for cervical cancer were randomised to receive either oxycodone (Group O) or conventional opioid regimens (Group C). The primary outcome was the CD4+/CD8+ ratios postoperatively at 24 and 48 h. Student’s t-test was used for normally distributed variables, the non-parametric Wilcoxon test for non-normally distributed variables, and Chi-square/Fisher’s exact test for qualitative variables, with differences significant set at P < 0.05. Results: We included 56 patients in the final analysis. The postoperative CD4+/CD8+ ratios were comparable between groups. However, the mean arterial pressures (MAPs) at extubation and 5 minutes thereafter were lower in Group O than in Group C (both P < 0.001), as were the heart rates (HRs) (P = 0.001 and 0.018, respectively). Within 24 h postoperatively, the visual analogue scale (VAS) scores for resting and movement-evoked pain were lower in Group O than in Group C (all P < 0.001), and the same was observed at 48 h postoperatively (both P = 0.002), as was the incidence of catheter-related bladder discomfort (P = 0.001). The VASs for postoperative analgesia satisfaction were higher in Group O than in Group C (P = 0.006). Conclusion: In laparoscopic surgery for cervical cancer, perioperative oxycodone as the sole opioid within a multi-modal analgesia framework does not yield anticipated benefits in immunopreservation compared to conventional opioid regimens but improves postoperative pain management and haemodynamic stability.

Effects of tumor spillage prevention in laparoscopic radical hysterectomy for early-stage cervical cancer: a propensity score-matched analysis.

Minimally invasive radical hysterectomy has a worse prognosis than open surgery, but the reasons for the poor prognosis remain unclear. Tumor spillage occurs when the tumor is exposed to the surgical field and has been suggested to be related to a poor prognosis. This study aimed to compare the prognostic value of tumor spillage in laparoscopic radical hysterectomy and evaluate whether tumor spillage prevention improves oncological safety. We compared the prognosis of patients who underwent laparoscopic radical hysterectomy between December 2014 and November 2021 with or without tumor spillage prevention, including surgeries without prevention and those with failed prevention. Prevention consisted of vaginal cuff formation or closure of the vaginal canal with clips to prevent tumor exposure at the time of colpotomy. The primary endpoint was disease-free survival, which was adjusted using propensity scores to compare patients. In total, 165 patients received tumor spillage prevention, and 61 did not or failed to receive such prevention. The median follow-up was 4.4 years. Patients who did not undergo prevention or failed prevention had significantly shorter disease-free survival than those who did (hazard ratio [HR]=3.54; 95% confidence interval [CI]=1.23-10.23). The same trend was observed after adjusting for propensity score matching. Patients who did not or failed to receive prevention were more likely to experience local recurrence (HR=4.01; 95% CI=1.13-14.24). Tumor spillage prevention was associated with longer disease-free survival in laparoscopic radical hysterectomy.

Minimally invasive vs. open surgery: comparison of surgical complications in radical hysterectomy for cervical cancer

Cervical cancer remains a significant global health concern, ranking as the third most prevalent malignancy and the second leading cause of cancer-related mortality among women in the United States. Early-stage cervical cancer is typically managed with radical hysterectomy, traditionally performed via open abdominal or vaginal approaches. Minimally invasive radical hysterectomy (MIS-RH) was introduced in 1993, yet findings from the laparoscopic approach to cervical cancer (LACC) trial have raised substantial concerns regarding the oncologic safety of the laparoscopic approach. As a result, abdominal radical hysterectomy (ARH) has been reaffirmed as the standard of care in surgical practice for cervical cancer. Despite this shift, some studies suggest that minimally invasive surgery (MIS), specifically laparoscopic radical hysterectomy (LRH), may be associated with fewer perioperative complications compared to open surgery. However, other studies report no significant differences in complication rates when comparing LRH to ARH. Persistent challenges in adopting MIS for cervical cancer treatment include the complexity of these procedures, extended learning curves, and increased costs. This narrative review provides a comprehensive comparison of LRH and ARH complications, offering insights into their safety, efficacy, and overall benefits to advance the ongoing discussion on optimal surgical approaches for cervical cancer treatment.

Clinical comparative study of robot-assisted and traditional laparoscopic surgery in patients with cervical cancer: a retrospective cohort study

BackgroundA new era in minimally invasive surgery has been ushered in by Leonardo’s robot surgical system, but the safety and effectiveness in cervical cancer is lake of evidence. This study aimed to compare the safety, effectiveness, and cost-effectiveness of robot-assisted laparoscopic radical hysterectomy (RRH) and conventional laparoscopic radical hysterectomy (LRH) in patients with cervical cancer.MethodsPatients with cervical cancer who had radical surgery at the first affiliated Hospital of Chongqing Medical University between January 2017 and June 2022 were enrolled. Patients in the LRH and RRH groups were matched 1:1 using propensity score matching (PSM), all patients were followed up to September 2023, cancer recurrence occurred or death, whichever came first.Results522 cervical cancer patients were enrolled in this study, 261 of whom were in the LRH group and 261 of whom were in the RRH group. Univariate analysis showed that the RRH group had less intraoperative blood loss, shorter operation time and hospital stay, lower incidence of composite complications and urinary retention, but had higher hospitalization costs. Multivariate Logistic regression analysis showed that LRH was an independent protective factor for composite complications (OR 1.531; 95%CI,1.022 to 2.295; P = .039). Cox regression analysis with cancer recurrence as the endpoint showed that LRH (HR 0.320; 95%CI,0.255 to 0.401; P < .001) and longer operation time (HR 0.995; 95%CI,0.993 to 0.997; P < .001) reduced 68% and 5% risk of cancer recurrence ; results also indicated that the older age (HR 1.017; 95%CI,1.007 to 1.027; P = .001) and postoperative complications (HR 22.410; 95%CI,16.019 to 31.350; P < .001) would increase 224% recurrence risk of cancer recurrence.ConclusionsBoth LRH and RRH demonstrated good short-term efficacy, with RRH outperforming LRH in terms of reduced intraoperative bleeding, shorter hospital stays and operation times, and fewer composite complications. However, the RRH group faces a higher risk of early cancer recurrence and incurs greater expenses. In summary, comprehensive long-term prospective studies are needed to thoroughly explore the effectiveness and safety of both LRH and RRH.

Oncologic Outcomes of Laparoscopic Radical Hysterectomy Incorporating Modified Tumor-Free Techniques.

It remains unclear whether modifying laparoscopic radical hysterectomy to adopt tumor-free principles can improve oncologic outcomes in patients with early-stage cervical cancer. We performed a single-center retrospective cohort study of 276 patients with early-stage cervical cancer who were treated between January 2017 and January 2023, including 151 patients who underwent laparoscopic radical hysterectomy that incorporated modified tumor-free techniques (MTF group) and 125 patients who underwent conventional laparoscopic radical hysterectomy with a uterine manipulator and unprotected intracorporeal colpotomy (non-MTF group). Oncologic outcomes and perioperative results were analyzed using inverse probability treatment weighting (IPTW). Patients in the MTF group had shorter length of hospital stay than those in the non-MTF group. However, there were no significant differences in operative time, decrease in hemoglobin, or complications. After a median follow-up of 36.0 months (range 15.3-62.0 months) for the MTF group and 66.8 months (range 3.0-82.5 months) for the non-MTF group, recurrence was observed in two (1.3%) and 16 (12.8%) of the patients, respectively. The 2-year disease-free survival (DFS) rates in the MTF group and non-MTF group were 99.3% and 91.9%, respectively. In the primary analysis limited to 2-year survival, the adjusted multivariate analysis showed that use of modified tumor-free techniques was an independent predictor of longer DFS (hazard ratio 0.10 95% CI, 0.01-0.77, P=.027). After IPTW, patients in the MTF group had a more favorable DFS than those in the non-MTF group (log-rank P=.031). Laparoscopic radical hysterectomy that incorporates modified tumor-free techniques is a feasible treatment for patients with early-stage cervical cancer. Oncologic outcomes of individuals who underwent this procedure were more favorable than those of conventional laparoscopic radical hysterectomy.

Post-radical hysterectomy ovarian torsion—A gynecological emergency: a case series

BackgroundOvarian torsion is a surgical emergency whereby the ovary twists, or torts, on its ligamentous support and potentially compromises vascular supply to both the ovary and Fallopian tube. It accounts for 2–3% of all acute gynecological emergencies, yet is a condition that is rarely reported to occur after hysterectomy.While it is well established that ovarian torsion can occur after laparoscopic hysterectomy, we report on the rare occurrence of ovarian torsion occurring post the supposedly preventative ovarian transposition suspension procedure or ovariopexy. This highlights that further evaluation of laparoscopic surgical techniques are required to prevent this exquisitely painful gynecological condition occurring postoperatively.Case presentationWe report two cases of ovarian torsion post-primary laparoscopic radical hysterectomy performed for cervical malignancy. Both patients were Caucasian, multiparous, premenopausal female patients, aged 37 and 39 years old.Ovarian transposition suspension was performed at the primary procedure to allow ovarian function to be preserved if the patient’s required postoperative pelvic irradiation if surgically upstaged. Both patients underwent emergency laparoscopic detorsion, with one torsion due to reoccurrence of her cervical cancer.ConclusionsAdnexal torsion is estimated to occur between 1% and 8% in post-hysterectomy cases. It can be a difficult to diagnose condition, with prudent history-taking, relevant investigations, and a low threshold to consider laparoscopy forming essential clinical acumen. Unfortunately, the suspension of the ovaries post-hysterectomy does not exclude future ovarian torsion. With rising rates of cervical cancer in premenopausal women, reportedly increasing by 37% in the 25–34 age range in the United Kingdom (National Cancer Registration and Analysis Service, Public Health England. 2021), further research is needed to improve techniques to allow for safe ovarian conservation for these patients while undergoing operative treatment of cervical cancer.

Cost-effectiveness of robotic surgery compared to conventional laparoscopy for the management of early-stage cervical cancer: a model-based economic evaluation in China

ObjectivesThe aim of this study is to assess cost-effectiveness of robotic radical hysterectomy (RRH) vs laparoscopic radical hysterectomy (LRH) in early-stage cervical cancer (ECC).DesignModel-based cost-effectiveness analysis.SettingBased on long-term survival data,...

Nerve-Sparing Laparoscopic Radical Hysterectomy (nsLRH) without Adjuvant Therapy in FIGO Stage IB3 Cervical Cancer Patients: Surgical Technique and Survival Outcomes.

(1) Background: In 2018 FIGO reclassified tumors confined to the cervix larger than 4 cm as stage IB3. Although concurrent CTRT has been the standard of care and surgery the alternative, optimal management remains controversial due to the lack of direct comparison between surgery and CTRT. (2) Methods: This prospective observational study investigated the efficacy, safety and oncologic outcomes of nerve-sparing laparoscopic radical hysterectomy (nsLRH) for FIGO stage IB3 cervical cancer patients (IB3). From 2009 to 2023, IB3 patients underwent laparoscopic pelvic lymphadenectomies with frozen section analysis, followed by a nsLRH if the lymph nodes were tumor-free. No uterine manipulator was used and the vaginal cuff was sealed before retrieving the specimen. Intermediate-risk patients were under close observation without adjuvant therapy. Outcomes were monitored until 2023. (3) Results: During the study period, 74 IB3 patients were treated. Sixty-eight (91.9%) underwent a nsLRH. A complete resection with negative margins was achieved in all cases. At a median of 68 months of follow-up, the disease-free survival (DFS) rate was 89.7% and the overall survival (OS) rate was 93.1%. The overall complication rate was 23.5% and there were no grade 4-5 complications. (4) Conclusions: In patients with IB3 cervical cancer, a nsLRH is safe and effective. While awaiting the results from ongoing randomized trials, these findings support nsLRH as a viable treatment.

The evaluation of surgical content in laparoscopic radical hysterectomy videos on YouTube

ObjectiveThis study aimed to evaluate the quality of surgical content in laparoscopic radical hysterectomy (LRH) videos on YouTube. Study DesignOn February 20, 2024, a search was conducted on YouTube using the keyword “laparoscopic radical hysterectomy,” filtering videos with durations over 20 min and sorting by relevance. Two experienced gynecologists assessed the first 250 videos retrieved to determine if they illustrated anatomical landmarks and surgical procedures in a standardized step-by-step manner. ResultsForty videos met the inclusion criteria for analysis. Sixty percent (24 out of 40) of these videos presented the complete list of predetermined surgical steps. According to the LAP-VEGaS assessment tool, only 32.5 % (13 out of 40) of the videos achieved a total score of 11 or higher, and 12.5 % (5 out of 40) scored 12 or higher. Videos with a LAP-VEGaS score of 11 or above had a statistically higher number of views per day (4.64 [IQR: 10.47]) compared to those with a lower score (1.48 [IQR: 3.40], p = 0.019). Additionally, videos featuring a didactic voice were significantly more popular, with higher views per day compared to those with music or no audio (8.66 [IQR: 32.75] vs. 1.69 [IQR: 3.12], p = 0.001). ConclusionThe majority of LRH videos on YouTube lacked comprehensive surgical content and received low LAP-VEGaS scores. Videos with a didactic voice and higher LAP-VEGaS scores tended to attract more viewers.

Association of a modified uterine manipulation method with improved recovery after laparoscopic radical hysterectomy: a retrospective cohort study

Objective: Uterine manipulation with an intrauterine device is the surgical method used for early-stage cervical cancer. In this study, we explored a modified uterine manipulation method without the using an intrauterine device during laparoscopic radical hysterectomy (LRH) of patients with early-stage cervical cancer. Methods: We retrospectively collected data of patients with early-stage cervical cancer who underwent LRH between January 2015 and June 2019. The clinicopathological characteristics and surgical outcomes of patients treated with the new method (Group S) were compared to those of patients treated with the conventional uterine manipulator (Group M). Results: A total of 100 patients were included in the study, with 54 patients in Group M and 46 patients in Group S. No significant difference was observed in clinicopathological characteristics between the two groups. Compared to Group M, Group S had a significantly shorter duration of postoperative fever (0 vs. 3 days, P = 0.003) and a shorter duration of secondary antibiotic use (4 vs. 5 days, P = 0.035). Additionally, the cost of antibiotics was lower in Group S ($95.45 vs. $135.22, P = 0.032). The modified uterine manipulation method was associated with a lower risk of postoperative fever (P = 0.007). No difference was found in the 2-year disease-free survival (P = 0.409) and 2-year overall survival between the two groups (P = 0.718). Conclusions: The modified uterine suture suspension method is easy to perform, enhances postoperative recovery, and could be a viable option for patients with early-stage cervical cancer.

A phase III randomized clinical trial comparing laparoscopic radical hysterectomy based on open state with abdominal radical hysterectomy in patients with early-stage cervical cancer

BackgroundCervical cancer is the fourth most frequently diagnosed cancer and the fourth leading cause of cancer death in women, The standard treatment recommendation for women with early cervical cancer is radical hysterectomy with pelvic lymph node dissection, however, articles published in recent years have concluded that the treatment outcome of laparoscopic surgery for cervical cancer is inferior to that of open surgery. Thus, we choose a surgically new approach; the laparoscopic cervical cancer surgery in the open state is compared with the traditional open cervical cancer surgery, and we hope that patients can still have a good tumor outcome and survival outcome. This trial will investigate the effectiveness of laparoscopic cervical cancer surgery in the open-state treatment of early-stage cervical cancer.Method and designThis will be an open-label, 2-armed, randomized, phase-III single-center trial of comparing laparoscopic radical hysterectomy based on open state with abdominal radical hysterectomy in patients with early-stage cervical cancer. A total of 740 participants will be randomly assigned into 2 treatment arms in a 1:1 ratio. Clinical, laboratory, ultrasound, and radiology data will be collected at baseline, and then at the study assessments and procedures performed at baseline and 1 week, 6 weeks, and 3 months, and follow-up visits begin at 3 months following surgery and continue every 3 months thereafter for the first 2 years and every 6 months until year 4.5. The primary aim is the rate of disease-free survival at 4.5 years. The secondary aims include treatment-related morbidity, costs and cost-effectiveness, patterns of recurrence, quality of life, pelvic floor function, and overall survival.ConclusionsThis prospective trial aims to show the equivalence of the laparoscopic cervical cancer surgery in the open state versus the transabdominal radical hysterectomy approach for patients with early-stage cervical cancer following a 2-phase protocol.Trial registrationChiCTR2300075118. Registered on August 25, 2023.

Oncologic Outcomes of Patients with Early-Stage Cervical Cancer after Minimally Invasive Radical Hysterectomy and Sentinel Lymph Node Biopsy.

Background: The sentinel lymph node is the first node that cancer cells reach when migrating from the primary site. However, oncological outcomes after sentinel lymph node biopsy (SNB) have not been reported for cervical cancer. In this study, oncological outcomes were compared between patients receiving SNB and pelvic lymphadenectomy (PLD) for early-stage cervical cancer. Methods: One hundred and four patients with clinical stage 1A2, 1B1, and 2A1 cervical cancer were included in this study. All patients underwent laparoscopic or robot-assisted radical hysterectomy with SNB or PLD. Fifty-two patients with tumors ≤2 cm underwent SNB. Disease-free survival (DFS) and overall survival (OS) were compared between the groups. Results: The median (interquartile range) tumor size was 12 (7-20) mm in the SNB group and 20 (13-25) mm in the PLD group. Lymph node metastasis occurred in one patient in the SNB group and in nine patients in the PLD group. The median follow-up periods were 42 (24-60) and 82 (19-101) months in the SNB group and PLD group, respectively. The 3-year DFS rates were 100% in SNB and 91.5% in PLD. The 3-year OS was 100% in both groups. Conclusions: SNB was sufficient in cervical cancer patients with tumors ≤2 cm, suggesting that PLD might not be necessary for these patients.

Evaluating the effectiveness of early urethral catheter removal combined with intermittent catheterization for promoting early recovery of bladder function after laparoscopic radical hysterectomy: a study protocol for a randomized controlled trial

BackgroundBladder dysfunction, notably urinary retention, emerges as a significant complication for cervical cancer patients following radical hysterectomy, predominantly due to nerve damage, severely impacting their postoperative quality of life. The challenges to recovery include insufficient pelvic floor muscle training and the negative effects of prolonged postoperative indwelling urinary catheters. Intermittent catheterization represents the gold standard for neurogenic bladder management, facilitating bladder training, which is an important behavioral therapy aiming to enhance bladder function through the training of the external urethral sphincter and promoting the recovery of the micturition reflex. Nevertheless, gaps remain in current research regarding optimal timing for intermittent catheterization and the evaluation of subjective symptoms of bladder dysfunction.MethodsCervical cancer patients undergoing laparoscopic radical hysterectomy will be recruited to this randomized controlled trial. Participants will be randomly assigned to either early postoperative catheter removal combined with intermittent catheterization group or a control group receiving standard care with indwelling urinary catheters. All these patients will be followed for 3 months after surgery. The study’s primary endpoint is the comparison of bladder function recovery rates (defined as achieving a Bladder Function Recovery Grade of II or higher) 2 weeks post-surgery. Secondary endpoints include the incidence of urinary tract infections, and changes in urodynamic parameters, and Mesure Du Handicap Urinaire scores within 1 month postoperatively. All analysis will adhere to the intention-to-treat principle.DiscussionThe findings from this trial are expected to refine clinical management strategies for enhancing postoperative recovery among cervical cancer patients undergoing radical hysterectomy. By providing robust evidence, this study aims to support patients and their families in informed decision-making regarding postoperative bladder management, potentially reducing the incidence of urinary complications and improving overall quality of life post-surgery.Trial registrationChiCTR2200064041, registered on 24th September, 2022.

Clinical Effect Analysis of Laparoscopic Nerve-Sparing Radical Hysterectomy in Patients with Early-Stage Cervical Cancer

Background: There is much controversy about the utility of open and laparoscopic surgery procedures for cervical cancer following the Laparoscopic Approach to Cervical Cancer (LACC) trial. The main objective of this study was to determine the utility of laparoscopic nerve-sparing radical hysterectomy (LNSRH) in improvement of postoperative bladder and rectal function and clinical outcomes of patients with common types of early-stage cervical cancer and tumor diameters &lt;2 cm. Methods: Ninety cases of common types of early-stage cervical cancer with tumor diameters &lt;2 cm were primarily treated with surgery from 2015 to 2021. Forty-five patients underwent LNSRH were classified as the study group and the remaining 45 patients underwent traditional abdominal radical hysterectomy (ARH) and classified as the observation group. The clinical and survival outcomes of the 2 groups were compared. Results: We observed no significant differences in the amount of blood loss, number of lymph nodes dissected, length of vaginal resection and length of parametrium resection between the two groups (p &gt; 0.05). The overall time of operation for LNSRH was longer than that for ARH (p &lt; 0.001). The Visual Analogue Scale (VAS) scores at 8, 24 and 48 hours were significantly different between the two groups (p &lt; 0.001). Catheter retention, flatus and spontaneous defecation times of the LNSRH group were significantly shorter than those of the ARH group (p &lt; 0.05). The proportion of patients with dysuria, abdominal pressure urination and constipation at 6 months after surgery in the LNSRH group was markedly lower relative to the ARH group (p &lt; 0.05). Evaluation of urodynamic parameters 12 months after surgery revealed faster recovery of the LNSRH group (p &lt; 0.05). Postoperative survival rates were not markedly different between the groups (p &gt; 0.05). Conclusions: Laparoscopic nerve-sparing radical hysterectomy is beneficial for patients with common types of early-stage cervical cancer and small tumors. The procedure effectively improves bladder and rectal function after surgery and promotes rapid recovery with no adverse effects on survival outcomes.

Robotic-assisted laparoscopic radical hysterectomy for early-stage cervical cancer: The more experienced the bedside assistant, the better?

BackgroundAim to investigate the impact of bedside assistant's work experience and learning curve on the short-term safety and efficacy in robotic-assisted laparoscopic radical hysterectomy for early-stage cervical cancer. MethodsOur research retrospectively retrieved 120 cases of early-stage cervical cancer patients who underwent robotic-assisted laparoscopic radical hysterectomy at the First Affiliated Hospital of Guangxi Medical University. According to the different work experiences of the two bedside assistants (BA), patients were divided into a research group (inexperienced BA 1) and a control group (experienced BA 2). Furthermore, the learning curves of these BAs were plotted separately and divided into two distinct phases by cumulative summation: the first learning phase and the second master phase. ResultIn terms of work experience, comparing BA 1 with BA 2 who was more experienced, although the average operative time was prolonged by 29 min (P＜0.001), it did not increase the incidence of operative complication [24.4 % VS 29.1 %, P = 0.583], positive resection margin [4.9 % VS 7.6 %, P = 0.714], intraoperative organ damage [0 % VS 2.5 %, P = 0.546] and there was no significant difference in the number of lymph nodes [19 VS 15, P = 0.103]. Additionally, comparing two distinct phases of the same bedside assistant, there was no significant increasing rate in terms of operative complication, positive resection margin, intraoperative organ damage, and the number of lymph nodes (P＞0.05) neither BA 1 nor BA 2, except for a slight extension of operative time about 20 min in learning phase (P＜0.05). ConclusionIn robotic-assisted laparoscopic radical hysterectomy for early-stage cervical cancer, work inexperience and the learning phase of BA only result in a slight extension of operative time, without causing worse short-term surgical outcomes.

VNOTES Radical Hysterectomy: A New Approach to Cervical Cancer

To demonstrate how a radical hysterectomy with sentinel node resection for cervical cancer can be performed via vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES). Demonstration of the technique in 10 steps. making use of narrated original video footage SETTING: The surgical treatment of cervical cancer is traditionally performed via one of the following techniques: Wertheim radical hysterectomy via laparotomy, Schauta radical hysterectomy vaginally, laparoscopic radical hysterectomy or robotic radical hysterectomy. The results of the LACC trial showed that minimally invasive radical hysterectomy was associated with lower rates of disease-free survival and overall survival than open radical hysterectomy among women with early-stage cervical Cancer [1]. For endometrial cancer, a vNOTES retroperitoneal approach to sentinel node resection was first published in 2019 [2]. Based on the experience with this approach and with Schauta-Stoeckel radical hysterectomy for cervical cancer [3], a new approach was developed to perform a radical hysterectomy via vNOTES whereby most of the procedure is performed retroperitoneally [4]. This video article demonstrates in 10 steps how a radical hysterectomy via vNOTES is performed. Radical hysterectomy via vNOTES demonstrated making use of original video footage of a 57-year-old woman operated on for cervical adenocarcinoma 7 weeks after a LEEP cone. The steps of the procedure are: 1. Vaginal cuff creation, 2. Development of lateral retroperitoneal space and sentinel node resection, 3. Uterine artery and vein transection, 4. Hypogastric nerve dissection, 5. Development of central retroperitoneal space and rectum dissection, 6. Posterior colpotomy, 7. Parametrium dissection, 8. Bladder pillar dissection, 9. Anterior colpotomy, 10. Salpingo-oophorectomy or salpingectomy. 3 Patients were so far treated by this new technique that allowed for good hemostatic control. vNOTES enables a potentially less invasive approach to radical hysterectomy performed largely retroperitoneally and completely transvaginally, leaving no visible scars. The endoscopic approach offers excellent visualization of the retroperitoneal and parametrial anatomy. This is a new approach that requires further validation and should only be performed in a research setting, taking into account the current reservations about endoscopic surgery for cervical cancer resulting from the LACC trial. VIDEO ABSTRACT.

Comparison of hysterectomy cases performed by transvaginal natural orifice transluminal endoscopic surgery: A paired sample cross-sectional study.

This study aimed to investigate the feasibility, indications, and benefits of transvaginal natural orifice transluminal endoscopic surgery (v-NOTES) hysterectomy for nonmalignant gynecological diseases. The clinical data, including the baseline information and surgical conditions of 81 patients who underwent v-NOTES hysterectomy for nonmalignant gynecological diseases in a tertiary university hospital from October 2018 to August 2022, were retrospectively analyzed and compared with the total laparoscopic hysterectomy group (200 cases) and the transumbilical laparoendoscopic Single Site Surgery group (150 cases). In comparison with the other 2 groups, the highest proportion of patients in the v-NOTES group had cervical intraepithelial neoplasia. Accordingly, mean preoperative uterine volume measured by sonography was significantly smaller in the v-notes group. In the v-NOTES group, the mean number of vaginal deliveries and age were significantly higher, while the mean number of previous abdominal surgeries was lower compared to the other 2 groups. The V-NOTES group had a shorter operation time, shorter postoperative urinary catheter insertion time, earlier intestinal recovery days, shorter hospital stay, and lower visual analogue scale scores after surgery, and the differences were statistically significant. When indicated appropriately, v-NOTES hysterectomy can be a feasible and advantageous surgical modality. In particular, in comparison to the laparoendoscopic Single Site Surgery and total laparoscopic hysterectomy groups, the v-NOTES group had advantages in postoperative recovery and had more aesthetic surgical results.

Comparison of surgical and oncological outcomes between different surgical approaches for overweight or obese cervical cancer patients

The purpose was to investigate the safety and advantages of different surgical approaches applied to overweight or obese cervical cancer patients by comparing their surgical and oncological outcomes. This is a retrospective cohort study. 382 patients with a body mass index of at least 24.0 kg/m2 and stage IB-IIA (The International Federation of Gynecology and Obstetrics, FIGO 2009) cervical cancer were enrolled, and then were divided into three groups: open radical hysterectomy (ORH) group, laparoscopic radical hysterectomy (LRH) group, and robot-assisted radical hysterectomy (RRH) group according to the surgical approach. IBM SPSS version 25.0 was used to analyze data. There were 51 patients in ORH group, 225 patients in LRH group and 106 patients in RRH group. In the comparison of surgical outcomes, compared to LRH and ORH, RRH had the shortest operating time, the least estimated blood loss, the shortest postoperative hospital stay, and the shortest recovery time for bowel function (P < 0.05). In the comparison of postoperative complications, ORH has the highest rate of postoperative infection and wound complication compared to LRH and RRH (P < 0.05), and RRH has the highest proportion of urinary retention. After a median follow-up time of 61 months, there was no statistically significant difference between the three groups in terms of 5-year overall survival (OS) rate and 5-year recurrence-free survival (RFS) rate, (P = 0.262, P = 0.453). In patients with overweight or obese cervical cancer, the long-term outcomes of the three surgical approaches were comparable, with RRH showing significant advantages over ORH and LRH in terms of surgical outcomes.

Comparison of 3D and 2D laparoscopy: Initial experience of perioperative outcomes and clinical assessment

IntroductionThis study was designed to compare three-dimensional (3D) laparoscopy and conventional two-dimensional (2D) laparoscopy in surgical performance and clinical assessment during laparoscopic radical hysterectomy with pelvic lymphadenectomy (LRHND) for treating early-stage cervical cancer. Material and methodsIn this study, we included 67 consecutive patients underwent LRHND for treating early-stage cervical cancer by the experienced laparoscopic surgeons between August 2018 and December 2020. amongst these patients, 32 patients underwent 3D laparoscopy (2D group) and 35 patients underwent 2D laparoscopy (2D group). Demographic data, clinical and surgical parameters were obtained from each patient. An end-of-operation questionnaire was administered regarding subjective perception of 3D laparoscopy system. ResultsPatient characteristics, including age, BMI, FIGO stage, and histology, were comparable between the two groups. Compared with 2D imaging system, 3D system significantly shortened the operation time, especially bilateral lymph node dissection time. Blood loss was lower in 3D group compared with 2D group. There were no significant differences regarding pelvic nodes retrieved, incidence of complications, hospital stay, the recovery time of bowel, abdominal drainage fluid, hospitalization costs and visual symptoms. In addition, 3D system significantly improved depth perception and precision, and reduced surgical strain and eye strain for surgeon. No statistical difference was observed in visual symptoms and adverse events between the two groups. The surgeon was more willing to accept 3D laparoscopy. ConclusionThe 3D laparoscopy is safe, feasible and comfortable, with obvious advantage in depth perception, precision and surgical strain. It triggered no increase in the complications and adverse events.

The clinical significance of intraoperative adverse events in laparoscopic radical hysterectomies for early-stage cervical cancer

ObjectiveSurgical quality plays a vital role in the treatment of malignant tumors. We investigated the classification of intraoperative adverse events (iAE) (ClassIntra) in relation to the surgical quality control of laparoscopic radical hysterectomies.MethodsA prospective cohort of 195 patients who had undergone laparoscopic radical hysterectomies for early stage cervical cancer between July 2019 and July 2021 was enrolled. Participants were classified into either an iAE or non-iAE groups in accordance with their intraoperative status. Surgical outcomes, patient satisfaction, and quality of life were compared between the two groups.ResultsOverall, 48 (24.6%) patients experienced 71 iAE. The iAE group was associated with significantly longer operative times (mean: 270 vs. 245 min, P < 0.001), greater blood loss (mean: 215 vs. 120 mL, P < 0.001), and longer postoperative hospital stays (median: 16 vs. 11 days). Larger tumors and poor technical performance significantly increased the risk of iAE (P < 0.05). Multivariate analysis revealed that iAE were the only independent risk factors for postoperative complications (hazard ratio, 15.100; 95% confidence interval: 4.735–48.158, P < 0.001). Moreover, patients who experienced iAE had significantly lower satisfaction scores and poorer quality of life (P < 0.05).ConclusionsClassIntra may serve as an effective adjunctive tool for surgical quality control in laparoscopic radical hysterectomies.