Laparoscopic Radical Hysterectomy Research Articles

Intracorporeal colpotomy using the Gutclamper as a novel clamping device to prevent tumor spillage during laparoscopic radical hysterectomy for cervical cancer.

Tumor cell spillage during the colpotomy has been suspected as one reason for poor oncologic outcomes in laparoscopic radical hysterectomy (LRH) for cervical cancer. To prevent such tumor spillage in LRH, we focused on use of a Gutclamper which is a device originally designed to clamp the colon and rectum during colorectal resections. A woman with stage IB1 cervical cancer underwent LRH using the Gutclamper. The Gutclamper was inserted into the abdominal cavity via 5-mm trocar, the vagina was clamped, and an intracorporeal colpotomy was performed caudal to this device. The Gutclamper can be used to clamp the vaginal canal and avoid the exposure of cervical tumor, regardless of the surgeon's skills or patient conditions. An intracorporeal colpotomy using the Gutclamper can contribute to the standardization of LRH.

Laparoscopic radical hysterectomy and total vaginectomy for vaginal malignant melanoma with cervical metastasis

The presented case is a 63-years-old multiparous woman admitted with the complaint of postmenopausal bleeding. On gynecologic examination multifocal lesions were detected, including 1 cm on lateral vaginal wall, 4 cm on posterior vaginal wall and 0.5 cm on the left lateral part of the cervix. Histopathology examination gave a diagnosis of epithelioid malignant melanoma. Consequently, laparoscopic radical hysterectomy and total vaginectomy with bilateral pelvic and inguinofemoral lymph node dissection were planned. On both sides, pararectal and paravesical spaces were created and the ureter was identified. Then, the vesicouterine and vesicovaginal spaces were developed. Uterine artery and superior vesical artery were coagulated, cut and the lateral parametrium was prepared. The left ureter was dissected and the ureteral tunnel was unroofed up to the bladder entrance. Subsequently, the anterolateral parametrium was transected. Then, the infundibulopelvic and sacrouterine ligaments were sealed and transected. At this time, the rectovaginal space was developed. Bilateral paracolpos were transected. The endopelvic fascia with the levator muscles were sealed and cut circumferentially. Anteriorly, the pubovesicocervical fascia was transected and the bladder was mobilized up to the uretrovesical junction. Thereafter, through a vaginal approach, the cervix and vagina were inverted by grasping the cervix with a tenaculum. An incision on the posterior vaginal wall at the introitus was made and the urogenital diaphragm was dissected to connect with the pelvic cavity. The vaginal entrance was cut circumferentially and the surgical specimen was extracted. In conclusion, laparoscopy can be considered as a feasible approach for radical hysterectomy and total vaginectomy in selected patients.

Comparison between laparoscopic and abdominal radical hysterectomy for cervical adenosquamous carcinoma at stage IA2 to IIA2: A multicenter retrospective study.

We aimed to compare the 5-year oncological outcomes of laparoscopic/abdominal radical hysterectomy (LRH/ARH) in patients with cervical adenosquamous carcinoma at stage IA2 to IIA2 based on the 2009 or 2018 International Federation of Gynecology and Obstetrics (FIGO) staging criteria. Based on the clinical diagnosis and treatment of cervical cancer in China (Four C) database, Cox risk regression models were applied to analyze tumor prognosis treated with ARH/LRH in FIGO 2009 and 2018 IA2-IIA2 patients and stratified findings according to tumor diameter (≤4 and >4cm subgroups). And to avoid bias, propensity score matching (PSM) was also used for the cohort study. Based on FIGO 2009 staging criteria (n=474), there was no significant difference between the ARH and LRH groups in 5-year disease-free survival (DFS) or overall survival (OS). Lymph node metastasis was a risk factor for 5-year DFS in this stage. After PSM, lymphovascular space invasion (LVSI) was an independent risk factor for 5-year OS in the tumors ≤4cm subgroup. Based on FIGO2018 staging criteria (n=322), cervical interstitial infiltration depth was an independent risk factor for 5-year OS in the total population and the tumor diameter ≤4cm subgroup. Laparoscopic surgery was not a risk factor affecting the oncologic prognosis of adenosquamous carcinoma of the cervix based on either FIGO 2009 or 2018 staging of stage IA2-IIA2. In addition, LRH may be considered for patients with early-stage cervical adenosquamous carcinoma.

Intraoperative breakage of a laparoscopic needle holder confirmed by postoperative abdominal X-ray: A case report and literature review

Introduction: Intraperitoneal retention of surgical instrument fragments may lead to severe complications. Therefore, such foreign bodies must be detected before surgery completion. We present a case with intraoperative breakage of a laparoscopic needle holder confirmed by a routine postoperative abdominal X-ray and review the literature regarding intraoperative laparoscopic instrument breakage. Case Report: A 58-year-old woman with stage IB1 cervical adenocarcinoma underwent a laparoscopic radical hysterectomy. Surgery was completed without major complications; however, an abdominal X-ray as a routine postoperative examination revealed a radiopaque shadow of approximately 3 mm corresponding to a broken part of the tissue-pad of the laparoscopic needle holder tip. It was successfully removed using laparoscopy with fluoroscopic guidance without further complications. According to the literature review, most of the instrument breakage were noticed during surgery as they were either obvious or impaired function. In our case, since the detached foreign body was extremely small and did not significantly affect needle holder function, it remained unnoticed until the postoperative X-ray was taken. Conclusion: Postoperative abdominal X-rays identify instrumental fragments infrequently; however, they may help detect intraperitoneal retention of foreign bodies and avoid serious complications following laparoscopic surgery.

Effect of annualized surgeon volume on major surgical complications for abdominal and laparoscopic radical hysterectomy for cervical cancer in China, 2004–2016: a retrospective cohort study

BackgroundPrevious studies have suggested that higher surgeon volume leads to improved perioperative outcomes for oncologic surgery; however, the effect of surgeon volumes on surgical outcomes might differ according to the surgical approach used. This paper attempts to evaluate the effect of surgeon volume on complications or cervical cancer in an abdominal radical hysterectomy (ARH) cohort and laparoscopic radical hysterectomy (LRH) cohort.MethodsWe conducted a population-based retrospective study using the Major Surgical Complications of Cervical Cancer in China (MSCCCC) database to analyse patients who underwent radical hysterectomy (RH) from 2004 to 2016 at 42 hospitals. We estimated the annualized surgeon volumes in the ARH cohort and in the LRH cohort separately. The effect of the surgeon volume of ARH or LRH on surgical complications was examined using multivariable logistic regression models.ResultsIn total, 22,684 patients who underwent RH for cervical cancer were identified. In the abdominal surgery cohort, the mean surgeon case volume increased from 2004 to 2013 (3.5 to 8.7 cases) and then decreased from 2013 to 2016 (8.7 to 4.9 cases). The mean surgeon case volume number of surgeons performing LRH increased from 1 to 12.1 cases between 2004 and 2016 (P < 0.01). In the abdominal surgery cohort, patients treated by intermediate-volume surgeons were more likely to experience postoperative complications (OR = 1.55, 95% CI = 1.11–2.15) than those treated by high-volume surgeons. In the laparoscopic surgery cohort, surgeon volume did not appear to influence the incidence of intraoperative or postoperative complications (P = 0.46; P = 0.13).ConclusionsThe performance of ARH by intermediate-volume surgeons is associated with an increased risk of postoperative complications. However, surgeon volume may have no effect on intraoperative or postoperative complications after LRH.

Short-term and Long-term Outcomes in Patients with Early-stage Cervical Cancer, Comparing Clinical and Adjuvant Therapy between Laparoscopic and Open Radical Hysterectomy: A Systematic Review and Meta-analysis

BACKGROUND: Cervical cancer represents one of the most common gynecological malignancies worldwide and the standard treatment has been radical abdominal hysterectomy (RAH). Recent surgical developments can be done through minimally invasive surgery (MIS) using laparoscopic radical hysterectomy (LRH), but the data regarding LRH are still conflicting. AIM: Therefore, we undertook a systematic review and meta-analysis comparing the short-term and long-term outcomes of laparoscopic versus RAH in women with early-stage cervical cancer. METHODS: A systematic search was performed within PubMed, Cochrane, Science Direct, and Google Scholar databases to research the outcome of LRH versus RAH in early-stage cervical cancer. Two reviewers independently reviewed titles, abstracts, and full article text to identify studies meeting inclusion and exclusion criteria. If there any discrepancies, it will be resolved by discussion. The Newcastle–Ottawa scale (NOS) was used to assess the risk of bias of non-randomized studies in this analysis. We used Review Manager 5.4 to calculate the result of 95% CI for the outcomes, odds ratio (OR), and mean differences (MD). The endpoints of interest are short-term, during operation, early post-operation, and long-term outcomes. RESULT: The initial search identified 3.030 citations after a comprehensive review of the final 35 observational studies included, involving 6.919 early-stage cervical cancer patients. Pooled analysis showed that LRH had better intraoperative outcomes, estimated blood loss (EBL) significantly lower LRH (MD = 145.88 [95% CI: 132.84–158.92; p &lt; 0.0001; I2 = 94%]), lesser intraoperative urinary tract injury (OR = 0.91), and vascular injury (OR = 0.76) but was not significant, number of pelvic lymph nodes resected tended to be higher in RAH with MD = 3.63 (95% CI: 3.10–4.15; p &lt; 0.0001; I2 = 95%), shorter bowel recovery time post-operative (MD = 0.05 [95% CI: 0.34–0.66; p &lt; 0.001]). Uniquely, the duration of surgery was not significantly different but still shorter in LRH with MD = 0.73. Long-term outcome was not significantly different for LRH from survival (OR = 1.17) and recurrence (OR = 0.83). LRH had shorter length of stay post-operative (MD = 13.23 [95% CI: 12.98–13.47; p &lt; 0.001; I2 = 100%]) and tend to use significantly fewer adjunctive chemotherapy treatments (OR = 1.84 [95% CI: 1.38–2.45; p &lt; 0.001; I2 = 73%]), the same was seen in radiotherapy treatment (OR = 1.27 [95% CI: 1.03–1.58; p = 0.03; I2 = 68%]). DISCUSSION: The result demonstrated that for the long-term outcome, there was no significant difference between the two techniques. In general, LRH is considered to be associated with better recovery, smaller scar, and faster back to normal life than ARH. Some comparative studies have reported that survival outcome and perioperative complications after LRH are comparable to those after ARH. However, some study found that MIS was associated with a higher risk of death than open surgery for patients with tumor size ≥2 cm (HR 1.66, 95% CI: 1.19–2.30) and had significantly worse progression-free survival than those in the open surgery group with tumor size &gt;2 cm and ≤4 cm (p = 0.044). This may be because of the use of uterine manipulator or because the difference approaches in handling the vaginal margin. Thus, avoiding tumor spillage and diminishing tumor handling during MIS may be beneficial. A Korean study demonstrated that LRH was associated with a lower total cost of care within 6-month postoperatively than RAH. It appeared that using laparoscopic approach was the least expensive approach from a societal perspective followed by robotic and then abdominal hysterectomy. CONCLUSION: This systematic review and meta-analysis of observational studies found that among patients who underwent radical hysterectomy for early-stage cervical cancer, LRH had a better outcome in intraoperative, faster post-operative recovery time, and less need for adjunctive therapy.

Analysis of the Efficacy of LNSRH Surgery for Early Cervical Cancer Based on T, B, and NK Lymphocytes

Background: The analysis is based on the level of T, B, NK lymphocytes to evaluate the efficacy of laparoscopic nerve-sparing radical hysterectomy (LNSRH) for early cervical cancer. Methods: Selected 30 patients with early cervical cancer who underwent LNSRH surgery in Tianjin Fifth Central Hospital from December 2019 to January 2021 as the cervical cancer group, and 30 healthy female who underwent physical examination in our hospital during the same period were selected as the control group. The expressions of CD4+, CD8+, CD20+, and CD57+ were detected by flow cytometer, female sexual function index (FSFI) and overall assessment scale of cancer treatment function (FACT-G) score were used to evaluate female sexual function and quality of life, and the receiver operating characteristic curve (ROC) was used to analyze the expression predictive value of CD4+, CD8+, CD20+, and CD57+ in LNSRH of early cervical cancer. Results: The expression of CD4+ and CD57+ in the cervical cancer group was lower than that in the healthy group,and the expression of CD8+ and CD20+ was higher than that in the healthy group (p &lt; 0.05). The expression of preoperative CD4+ and CD57+ was higher for postoperative, and the expression of preoperative CD8+ and CD20+ was lower (p &lt; 0.05) for postoperative. The expression of postoperative 1 day CD4+ and CD57+ was higher for at 3 days postoperative, and the expression of postoperative 1 day CD8+ and CD20+ was lower at 3 days postoperative (p &lt; 0.05). CD4+, CD57+ expression was positively correlated with FSFI score, and CD8+, and CD20+ expression was negatively correlated with FSFI score, CD4+, and CD57+ expression was positively correlated with FACT-G score, and CD8+, and CD20+ expression was negatively correlated with FACT-G score (p &lt; 0.05). ROC analysis of CD4+, CD8+, CD20+, CD57+ expression sensitivity was lower than the four-item combination, the specificity was higher than the four-item combination and the results with significant statistical difference (p &lt; 0.05) and the four combined tests have good predictive value for the efficacy of LNSRH for early cervical cancer (p &lt; 0.05). Conclusions: Cervical cancer patients were mainly cellular immunity and performed low expression of CD4+, high expression of CD8+, high expression of CD20+, and low expression of CD57+. T, B, and NK lymphocytes could be used for immunological detection of cervical cancer.

Effects of colpotomic approaches on prognosis and recurrence sites of stage Ⅰa2-Ⅱa2 cervical cancer after laparoscopic radical hysterectomy

Objective: To investigate the factors affecting the prognosis of stage Ⅰa2-Ⅱa2 cervical cancer after laparoscopic radical hysterectomy (LRH), and to compare the prognosis and recurrence sites of patients with different colpotomy paths. Methods: The clinical data of 965 patients with stage Ⅰa2-Ⅱa2 cervical cancer who underwent LRH in the First Affiliated Hospital of Army Medical University from January 2015 to December 2018 were collected. The median age was 47.0 years of all patients with a median follow-up of 62 months (48-74 months). Cox regression was used to perform the univariate and multivariate analysis of the clinicopathological factors associated with the prognosis that included disease-free survival (DFS) and overall survival (OS). Patients were categorized into LRH through vaginal colpotomy (VC group, n=475) and LRH through intracorporeal colpotomy (IC group, n=490) according to the colpotomic approaches. The prognosis and recurrence sites of patients in each group were compared. Results: (1) During the follow-up period, 137 cases recurred (14.2%, 137/965) and 98 cases died (10.2%, 98/965). The 5-year DFS and OS were 85.8% and 89.9%, respectively. In univariate analysis, positive vaginal margin (PVM) was significantly affected the 5-year OS of patients with cervical cancer (P=0.023), while clinical stage, maximum diameter of tumor, degree of pathological differentiation, lymph node metastasis (LNM), depth of cervical stromal invasion, parametrium involvement, and uterine corpus invasion (UCI) were significantly associated with 5-year DFS and OS in patients with cervical cancer (all P<0.05). In multivariate analysis, clinical stage (HR=1.882, 95%CI: 1.305-2.716), LNM (HR=2.178, 95%CI: 1.483-3.200) and UCI (HR=3.650, 95%CI: 1.906-6.988) were independent risk factors of 5-year DFS (all P<0.001). Clinical stage (HR=2.500, 95%CI: 1.580-3.956), LNM (HR=2.053, 95%CI: 1.309-3.218), UCI (HR=3.984, 95%CI: 1.917-8.280), PVM (HR=3.235, 95%CI: 1.021-10.244) were independent risk factors of 5-year OS (all P<0.05). (2) Different colpotomy paths did not significantly affect the 5-year DFS and OS of patients with stage Ⅰa2-Ⅱa2 cervical cancer. The 5-year DFS in VC group and IC group were 85.9% and 85.6% (P=0.794), and the 5-year OS were 90.8% and 89.3% (P=0.966), respectively. Recurrence patterns consisted of intraperitoneal recurrence, pelvic recurrence, vaginal stump recurrence, and lymph node and distant metastasis. The intraperitoneal recurrence rate of VC group was significantly lower than that of IC group [0.6%(3/468) vs 2.3% (11/485), P=0.037], while the rates of pelvic recurrence, vaginal stump recurrence, lymph node and distant metastasis and overall recurrence were not significantly different between two groups (all P>0.05). Subgroup analysis of patients with different clinical stages, LNM and UCI showed that statistical differences of the intraperitoneal recurrence rates between two groups were only in patients without LNM (0.5% vs 2.3%, P=0.030) or without UCI (0.7% vs 2.3%, P=0.037). Conclusions: Clinical stage, LNM, PVM and UCI are independent risk factors for the prognosis of patients with stage Ⅰa2-Ⅱa2 cervical cancer. For patients without LNM or UCI, LRH through VC could reduce the intraperitoneal recurrence rate, while it is not enough to improve 5-year DFS and OS of patients. Low proportion of intraperitoneal recurrence, intra-operative tumor cells spillage to vagina stump and pelvic cavity might be the explanation.

Learning Laparoscopic Radical Hysterectomy: Are We Facing an Emerging Situation?

Despite wide screening campaigns and early detection, cervical cancer remains the fourth most common cancer among women. Radical hysterectomy, whether by open, laparoscopic or by robotic-assisted techniques, is the mainstay treatment. However, for adequate surgical results and good oncological prognosis, a gynecological surgeon should be trained to perform those procedures. The learning curve of radical hysterectomy, especially by laparoscopy, is influenced by several factors. The LACC trial, the decrease in cervical cancer incidence and radical hysterectomy procedures have widely reduced the learning curve for surgeons. This article mainly discusses the learning curve of laparoscopic radical hysterectomy for cervical cancers, and how several factors are influencing it negatively, with the need to have medical authorities reset specific surgical training programs and allocate them to special oncological centers.

Meta-analysis of laparoscopic radical hysterectomy, excluding robotic assisted versus open radical hysterectomy for early stage cervical cancer

Recent evidence has shown an increase in recurrence and a decrease in overall survival in patients treated with laparoscopic radical hysterectomy (LRH) and robotic assisted radical hysterectomy (RRH) open techniques (ORH). In addition, several high quality trials were recently published regarding the laparoscopic treatment of early stage cervical cancer. We sought out to reassess the recurrence rates, overall survival, complications and outcomes associated with laparoscopic radical hysterectomy (LRH) techniques against open techniques (ORH) when robotic assisted techniques were excluded. We searched PubMed, Medline, Cochrane CENTRAL, SCOPUS, ClinicalTrials.Gov and Web of Science for relevant clinical trials and observational studies. We included all studies that compared with early stage cervical cancer receiving LRH compared with ORH. We included randomized clinical trials, prospective cohort, and retrospective cohort trials. We included studies that included LRH and RRH as long as data was available to separate the two arms. We excluded studies that combined LRH and RRH without supplying data to differentiate. Of 1244 total studies, we used a manual three step screening process. Sixty studies ultimately met our criteria. We performed this review in accordance with PRISMA guidelines. We analyzed continuous data using mean difference (MD) and a 95% confidence interval (CI), while dichotomous data were analyzed using odds ratio (OR) and a 95% CI. Review Manager and Endnote software were utilized in the synthesis. We found that when excluding RRH, the was no significant difference regarding 5-year overall Survival (OR = 1.24 [0.94, 1.64], (P = 0.12), disease free survival (OR = 1.00 [0.80, 1.26], (P = 0.98), recurrence (OR = 1.01 [0.81, 1.25], (P = 0.95), or intraoperative complications (OR = 1.38 [0.94, 2.04], (P = 0.10). LRH was statistically better than ORH in terms of estimated blood loss (MD = − 325.55 [− 386.16, − 264.94] (P < 0.001), blood transfusion rate (OR = 0.28 [0.14, 0.55], (P = 0.002), postoperative complication rate (OR = 0.70 [0.55, 0.90], (P = 0.005), and length of hospital stay (MD = − 3.64[− 4.27, − 3.01], (P < 0.001). ORH was superior in terms of operating time (MD = 20.48 [8.62, 32.35], (P = 0.007) and number of resected lymph nodes (MD = − 2.80 [− 4.35, − 1.24], (P = 0.004). The previously seen increase recurrence and decrease in survival is not seen in LRH when robotic assisted techniques are included and all new high quality is considered. LRH is also associated with a significantly shorter hospital stay, less blood loss and lower complication rate.Prospero Prospective Registration Number: CRD42022267138.

Robot-assisted versus conventional laparoscopic radical hysterectomy in cervical cancer stage IB1.

Objective: The aim of this study was to compare survival outcomes of robot-assisted laparoscopic radical hysterectomy (RRH) and conventional laparoscopic radical hysterectomy (LRH) in cervical cancer stage IB1. Method: This is a retrospective study of patients with cervical cancer stage IB1 who surgically treated by either RRH or LRH. Oncologic outcomes of the patients were compared according to surgical approach. Results: In total, 66 and 29 patients were assigned to LRH and RRH groups. All patients had stage IB1 disease (FIGO 2018). Intermediate risk factors (tumor size, LVSI, and deep stromal invasion), proportion of patients receiving adjuvant therapy (30.3% vs. 13.8%, p = 0.09), and median follow-up time (LRH, 61 months; RRH, 50 months; p=0.085) did not differ significantly between the two groups. The recurrence rate was higher in the LRH group; however, there was no significant difference between the two groups (p=0.250). DFS (55.4 vs 48.2 months, p = 0.250), and OS (61.2 vs 50.0 months, p = 0.287) were similar between the LRH and RRH groups. Conclusion: In patients with a tumor size < 2 cm, the recurrence rate was lower in RRH group; however, there was no significant difference. Further large-scale RCTs and clinical studies are required to provide relevant data.

Complications of Gynecologic Surgery: Vaginal Cuff Dehiscence after Total Laparoscopic Radical Hysterectomy

A 34-year-old woman G = 2 P = 2 completed parity was diagnosed with an abnormal PAP smear definite as AGC (Atypical Glandular Cells), seen in our center for a second opinion. The Bethesda system classifies atypical glandular cells (AGC) as glandular cells that demonstrate nuclear atypia appearing to exceed reactive or reparative changes but lacking certain features of adenocarcinoma.

Comparative single-center study between modified laparoscopic radical hysterectomy and open radical hysterectomy for early-stage cervical cancer

BackgroundSince the release of the LACC trial results in 2018, the safety of laparoscopic radical hysterectomy (LRH) for cervical cancer has received huge attention and heated discussion. We developed modified laparoscopic radical hysterectomy (MLRH) incorporating a series of measures to prevent tumor spillage, which has been performed in our center since 2015.ObjectivePresent study retrospectively analyzed relevant indicators of MLRH and evaluated disease-free survival (DFS) primarily in the treatment of early cervical cancer compared with open surgery.MethodsPatients with 2014 International Federation of Gynecology and Obstetrics clinical stages 1B1 and 2A1 cervical cancer who underwent radical hysterectomy in the gynecological department of our hospital from October 2015 to June 2018 were enrolled retrospectively in this study. Patients were divided into two groups based on the surgical procedure: open radical hysterectomy (ORH) group (n = 336) and MLRH group (n = 302). Clinical characteristics, surgical indices, and survival prognosis were analyzed, including 2.5-year overall survival (OS) rate, 2.5-year DFS rate, recurrence rate, and recurrence pattern.ResultsCompared to the ORH group, the MLRH group exhibited a longer operative time, longer normal bladder function recovery time, less intraoperative blood loss volume, and more harvested pelvic lymph nodes (P < 0.05). No significant differences were observed in postoperative complications, the 2.5-year OS, 2.5-year DFS, and recurrence rate between the two groups (P > 0.05); however, the recurrence pattern was significantly different (P < 0.05). The MLRH group mainly exhibited local single metastasis (7/11), whereas the ORH group mainly exhibited distant multiple metastases (14/16). Stratified analysis revealed that overall survival rate was higher in the MLRH group than in the ORH group in patients with stage 1B1 and middle invasion (P < 0.05).ConclusionMLRH does not show a survival disadvantage in the treatment of early-stage cervical cancer when compared with open surgery. In addition, MLRH shows a survival advantage in patients with stage 1B1 and middle 1/3 invasion. Considering this is a retrospective study, further prospective study is necessary for more sufficient data support.Trial registrationPresent research is a retrospective study. The study had retrospectively registered on Chinese Clinical Trial Registry (http://www.chictr.org.cn/), and the registered number is ChiCTR1900026306.

Comparative Study between Different Methods of Laparoscopic Hysterectomies

Background: Hysterectomy is the second most common major surgical procedure performed on women after caesarean section. The incidence of hysterectomy is 4-6% out of which 90% are performed for benign indications. Aim of the work: The aim of this study was to compare intra- and post-operative morbidity associated with two types of laparoscopic hysterectomy. Laparoscopic-Assisted Vaginal Hysterectomy (LAVH) and Total Laparoscopic Hysterectomy (TLH) Patients and methods: A total of 80 women scheduled to undergo a hysterectomy for benign disease were subdivided into 2 groups; 40 women for LAVH and 40 women for TLH, Patients were excluded from the study if they had contraindication to laparoscopy. Intra- and post-operative evaluations including the duration of the operation uterine weight, frequency of intraoperative complication, and the difference between hemoglobin level prior to surgery and one day after surgery. Results: LAVH took the longest operating time. As regard hemoglobin deficit that occurred after 24 hours of surgery, our study showed that TLH had largest Hb deficit (1.6 gm/dl) but still the Hb deficit not significantly different. As regard transfusion of blood, one case took blood in group LAVH and one case in group TLH. As regard other complications, the bladder was injured during plunt dissection of the bladder flap in group TLH and this case was having history of one cesarean section 10 years ago. Conclusion: laparoscopic assisted vaginal hysterectomy showed lower complication but longer operative time than total laparoscopic hysterectomy group; also (LAVH) showed shorter hospital stay and need fewer analgesics so we considered this method the best when the patient accepted total removal of the uterus. While total laparoscopic hysterectomy showed the more blood loss and complication intraoperatively and postoperatiovely, but this complication is non-significant in cases of removal of the hole uterus.

Survival after laparoscopic radical surgery for stage IA-IIB cervical cancer: 1316 consecutive cases from a national laparoscopic training center in China.

To investigate the survival of cervical cancer patients undergoing laparoscopic radical hysterectomy (LRH) in a minimally invasive gynecology center. A consecutive series of patients undergoing first LRH for cervical cancer from May 2008 to December 2017 at a national laparoscopic training center was retrospectively analyzed. The overall survival (OS) and progression-free survival (PFS) were compared between groups. In total, 1316 women with FIGO (2009) stage IA-IIB cervical cancer received LRH. Among them, 1114 (84.7%) were followed up for 3months or longer; the median follow-up period was 48months (range 3-144months). In patients with stage IA, IB1 (≤ 2cm), IB1 (> 2cm), IB2, IIA1 and IIA2-IIB tumors, the 4-year PFS rates were 98.6, 94.5, 87.4, 65.6, 80.0 and 67.4%, respectively, and the 4-year OS rates were 98.6, 96.8, 91.1, 77.4, 85.6 and 76.2%, respectively. The 4-year PFS and OS were as high as 96.2 and 97.5%, respectively, in patients with squamous cell carcinoma of 2cm or smaller in diameter. A stable high 4-year OS and PFS was achieved after completing 100 LRHs. In patients operated on by the same surgeon, an improvement in survival was observed after 40 LRHs. Favorable oncologic outcomes can be achieved in patients with IA-IB1 cervical cancer after LRH in a center with a high surgery volume.

Association of preoperative conization with recurrences after laparoscopic radical hysterectomy for FIGO 2018 stage IB1 cervical cancer

ObjectiveTo evaluate association of preoperative conization with recurrences after laparoscopic radical hysterectomy (LRH) for FIGO 2018 stage IB1 cervical cancer.MethodsThis is a retrospective single-center study. Patients who underwent LRH for cervical cancer with squamous, adenosquamous and adenocarcinoma subtype from January 2014 to December 2018 were reviewed. All patients were restaged according to the 2018 FIGO staging system. Those who were in FIGO 2018 stage IB1 met the inclusion criteria. General characteristics and oncologic outcomes including recurrence-free survival (RFS) were analyzed.ResultsA total of 1273 patients were included in the analysis. 616 (48.4%) patients underwent preoperative biopsy, and 657 (51.6%) patients underwent conization. Residual disease was observed in 822 (64.6%) patients. During a median follow-up of 50.30 months, 30 (2.4%) patients experienced recurrence. The univariate analysis showed that patients who had larger tumor diameter, the presence of residual tumor at final pathology, and underwent adjuvant treatment had a significant higher risk of recurrence (P < 0.01). Conversely, patients who underwent conization were significantly less likely to experience recurrence (P = 0.001). In the multivariate analysis, the independent risk factor associated with an increased risk of recurrence was resident macroscopic tumor (HR: 38.4, 95% CI 4.20–351.64, P = 0.001). On the contrary, preoperative conization was associated with a significantly lower risk of recurrence (HR: 0.26; 95% CI 0.10–0.63, P = 0.003). The Kaplan–Meier curves showed patients who underwent conization had improved survival over those who underwent biopsy (5 year RFS: 98.6 vs 95.1%, P = 0.001). The 5 year RFS of patients with residual tumor was significantly different (R0: 99.2%, R1: 97.4%, R2: 93.6%, P < 0.001), especially the patients with residual macroscopic tumor after conization (R0: 99.5%, R1: 99.0%, R2:92.4%, P = 0.006).ConclusionPreoperative conization and the absence of residual tumor at the time of surgery might play a protective role in patients with FIGO 2018 IB1 cervical cancer following LRH, which support the theory of the influence of intraoperative tumor spread during radical hysterectomy. Further prospective evidence is needed.

Overview of laparoscopic surgery for cervical cancer in Japan: Updates after the laparoscopic approach to cervical cancer trial.

Laparoscopic radical hysterectomy (LRH) for cervical cancer has been reported to be similar oncologic outcome compared to abdominal radical hysterectomy (ARH) in many retrospective studies. In Japan, LRH has been covered by insurance since April 2018. In 2018, the same year that LRH became covered by insurance, Ramirez et al. at MD Anderson Cancer Center reported the results of a large phase III laparoscopic approach to cervical cancer trial (LACC trial) on the prognosis of open versus laparoscopic/robot-assisted minimally invasive radical hysterectomy. The results showed that minimally invasive approaches were associated with a higher rate of recurrence and death. At this point, it is not clear what is wrong with LRH and why it has a poorer prognosis compared to ARH. In this report, after the LACC report, we would like to review the current status of minimally invasive surgery for cervical cancer and future directions.

Meta-Analysis of Laparoscopic Radical Hysterectomy vs. Robotic Assisted Radical Hysterectomy for Early Stage Cervical Cancer

Study Objective Although laparoscopic radical hysterectomy (LRH) and robotic radical hysterectomy (RRH) are both minimally invasive procedures commonly performed for the treatment of early-stage cervical cancer, there is little high quality data on the head-to-head comparison of these two procedures. We sought to perform the largest study to date to compare the efficacy and complications of these two procedures. Design Systematic Review and Meta-Analysis. Setting Gynecologic Oncology. Patients or Participants Women suffering from early-stage cervical cancer. We included retrospective cohorts, prospective cohorts, case-control, and randomized clinical trials. Interventions Laparoscopic radical hysterectomy compared with Robotic radical hysterectomy. Measurements and Main Results We found that following RRH, women had a decreased hospital stay (MD=0.80[0.38,1.21], (P<0.002). We found no differences in estimated blood loss (MD=35.24[-0.40,70.89],(P=.05), blood transfusion rate ((OR=1.32[0.86,2.02],(P=0.20), rate of post-operative complications (OR=0.84[0.60,1.17],(P=0.30), the operative time (MD=6.01[-4.64,16.66],(P=0.27), number of resected lymph node (MD=-1.22[-3.28,0.84],(P=0.25) intraoperative complications (OR=0.78[0.51,1.19],(P=0.25), five-year overall survival (OR=1.37[0.51,3.69],(P=0.53), lifetime disease free survival (OR=0.89[0.59,1.32],(P=0.55), intraoperative and postoperative mortality (within 30 days) (OR=1.30[0.66,2.54],(P=0.44), and recurrence (OR=1.14[0.79,1.64],(P = 0.50). Conclusion RRH seems to result in the patient leaving the hospital sooner after surgery. We were unable to find any differences in our ten other outcomes related to complications or efficacy. Although laparoscopic radical hysterectomy (LRH) and robotic radical hysterectomy (RRH) are both minimally invasive procedures commonly performed for the treatment of early-stage cervical cancer, there is little high quality data on the head-to-head comparison of these two procedures. We sought to perform the largest study to date to compare the efficacy and complications of these two procedures. Systematic Review and Meta-Analysis. Gynecologic Oncology. Women suffering from early-stage cervical cancer. We included retrospective cohorts, prospective cohorts, case-control, and randomized clinical trials. Laparoscopic radical hysterectomy compared with Robotic radical hysterectomy. We found that following RRH, women had a decreased hospital stay (MD=0.80[0.38,1.21], (P<0.002). We found no differences in estimated blood loss (MD=35.24[-0.40,70.89],(P=.05), blood transfusion rate ((OR=1.32[0.86,2.02],(P=0.20), rate of post-operative complications (OR=0.84[0.60,1.17],(P=0.30), the operative time (MD=6.01[-4.64,16.66],(P=0.27), number of resected lymph node (MD=-1.22[-3.28,0.84],(P=0.25) intraoperative complications (OR=0.78[0.51,1.19],(P=0.25), five-year overall survival (OR=1.37[0.51,3.69],(P=0.53), lifetime disease free survival (OR=0.89[0.59,1.32],(P=0.55), intraoperative and postoperative mortality (within 30 days) (OR=1.30[0.66,2.54],(P=0.44), and recurrence (OR=1.14[0.79,1.64],(P = 0.50). RRH seems to result in the patient leaving the hospital sooner after surgery. We were unable to find any differences in our ten other outcomes related to complications or efficacy.

Surgical Anatomy of Nerve as Seen in Nerve Sparing Radical Hysterectomy for Endometrial CA (>50% INVASION)

<h3>Study Objective</h3> surgical anatomy of nerves in nerve sparing radical hysterectomy in endometrial CA (>50% invasion). <h3>Design</h3> Prospective analysis. <h3>Setting</h3> Patient underwent 3D laparoscopy all the procedure done by experienced and qualified team/ <h3>Patients or Participants</h3> CA endometrium with >50 % invasion. <h3>Interventions</h3> Nerve sparing laparoscopy done. <h3>Measurements and Main Results</h3> in all patients reviewed at monthly interval followed by 3 monthly interval with USG (A+P) PET scan done at the end of 6 month did not reveal any recurrence. median follow-up 18 months. faster recovery of bladder function, good anorectal function, better sexual arousal and response. <h3>Conclusion</h3> By knowing the better knowledge about all pelvic nerves we can achieve a laparoscopic nerve sparing radical hysterectomy and give better life to patient. as a surgeon knowledge of predictive surgical anatomy of nerve is must.

Laparoscopic Versus Abdominal Radical Hysterectomy for Cervical Cancer: A Meta-analysis of Randomized Controlled Trials.

Laparoscopic radical hysterectomy (LRH) and open abdominal radical hysterectomy (ARH) have been used for cervical cancer treatment. We aimed to perform a meta-analysis to compare the efficacy and safety of LRH and ARH in the treatment of cervical cancer to provide reliable evidence to the clinical cervical cancer treatment. Two investigators independently searched PubMed and other databases for randomized controlled trials (RCTs) comparing LRH and ARH for cervical cancer treatment up to May 31, 2022. The risk of bias assessment tool recommended by Cochrane library was used for quality assessment. RevMan 5.3 software was used for meta-analysis. Fourteen RCTs with a total of 1700 patients with cervical cancer were finally included. Meta-analyses indicated that compared with ARH, LRH reduced the intraoperative blood loss (mean difference [MD]=-58.08; 95% CI, -70.91, -45.24), the time to first passage of flatus (MD=-14.50; 95% CI, -16.55, -12.44) (all P <0.05), and increase the number of lymph nodes removed (MD=3.47; 95% CI, 0.51, 6.43; P =0.02). There were no significant differences in the duration of surgery (MD=27.62; 95% CI, -6.26, 61.49), intraoperative complications (odd ratio [OR]=1.10; 95% CI, 0.17, 7.32), postoperative complications (OR=0.78; 95% CI, 0.33, 1.86), relapse rate (OR=1.45; 95% CI, 0.56, 3.74), and survival rate (OR=0.75; 95% CI, 0.52, 1.08) between LRH group and ARH group (all P >0.05). LRH has more advantages over ARH in the treatment of cervical cancer. Still, the long-term effects and safety of LRH and ARH need more high-quality, large-sample RCTs to be further verified.