Frequently before but regularly during surgery of breast cancer, epithelial cells are mobilized into circulation. Part of these cells, most probably normal or apoptotic cells, are cleared from the circulation as also shown to occur in benign conditions. After resection even if complete and of small tumors, cells can remain in the circulation over long times. Such cells may remain "dormant" but might settle and grow into metastases, if they find appropriate conditions, even after years.

In laparoscopy-assisted radical vaginal hysterectomy, laparoscopy is used to develop the paravesical and pararectal spaces. The cardinal ligament is isolated and cut after bipolar coagulation to the level of the deep uterine vein. By the vaginal approach, the ureters are identified before their entry into the bladder pillar. The uterine vessels are pulled down until their laparoscopically coagulated ends become visible. After incision of the vesicocervical reflection, the uterine fundus is grasped and developed (Döderlein maneuver). The lower cardinal and uterosacral ligaments are exposed by pulling the cervix and fundus uteri to the contralateral side. The cardinal and uterosacral ligaments are dissected and ligated, and the specimen is removed. We combined laparoscopic lymphadenectomy with radical vaginal hysterectomy in 33 women with cervical cancer. The mean operating time was 80 minutes for the vaginal phase and 215 minutes for the laparoscopic phase, including paraaortic and pelvic lymphadenectomy and preparation of the cardinal ligaments. Blood transfusions were necessary in four women. Three patients sustained injury to the bladder, one patient to the left ureter, and another patient to the left internal iliac vein. Repair was achieved at primary surgery for all intraoperative complications. No fistula was observed. The patients had fully recuperated after a mean of 28 days. The laparoscopy-assisted Schauta-Stoeckel approach may prove to be a safe alternative to conventional radical abdominal hysterectomy.

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