A case-controlled study of total laparoscopic radical hysterectomy with pelvic lymphadenectomy versus radical abdominal hysterectomy in a fellowship training program

Abstract

To determine whether total laparoscopic radical hysterectomy (TLRH) is a feasible alternative to an abdominal radical hysterectomy (ARH) in a gynecologic oncology fellowship training program. We prospectively collected cases of all of the patients with cervical cancer treated with TLRH and pelvic lymphadenectomy by our division from 2000 to 2006. All of the patients from the TLRH group were matched 1:1 with the patients who had ARH during the same period based on stage, age, histological subtype, and nodal status. Thirty patients were treated with TLRH with a mean age of 48.3 years (range, 29-78 years). The mean pelvic lymph node count was 31 (range, 10-61) in the TLRH group versus 21.8 (range, 8-42) (P < 0.01) in the ARH group. Mean estimated blood loss was 200 cc (range, 100-600 cc) in the TLRH with no transfusions compared to 520 cc in the ARH group (P < 0.01), in which five patients required transfusions. Mean operating time was 318.5 min (range, 200-464 min) compared to 242.5 min in the ARH group (P < 0.01), and mean hospital stay was 3.8 days (range, 2-11 days) compared to 5.6 days in the ARH group (P < 0.01). All TLRH cases were completed laparoscopically. All patients in the TLRH group are disease free at the time of this report. In conclusion, it is feasible to incorporate TLRH training into the surgical curriculum of gynecologic oncology fellows without increasing perioperative morbidity. Standardization of TLRH technique and consistent guidance by experienced faculty is imperative.

Total laparoscopic radical hysterectomy for treatment of uterine malignant tumors: Analysis of short-term therapeutic efficacy

“…The movement of optical tube and the switch of operation vision field can expose the hidden areas in laparotomy, making the procedures such as removal of paravaginal tissues and deep obturator lymph nodes more accurate and complete. The pelvic lymph node count in this study was 26.0±5.8, which was consistent with that reported by other scholars in recent years [10] .…”

“…After the operation the lymph nodes were found to have metastasis. The operative time, only 200.6±38.6 min, was about 100 min shorter than that reported at present by many scholars, and the average intraoperative blood loss (300 mL) was not significantly increased compared to other researches [10,15] . Our findings indicated that use of the surgical devices such as harmonic scalpel and bipolar electrocautery can reduce surgical time and improve the quality of surgery, and also facilitate the recovery.…”

“…Studies on the efficacy of the TLRH plus pelvic lymph node dissection for the treatment of the early cervical cancer indicated TLRH has the advantage of small trauma and less bleeding, faster postoperative recovery over the tradition abdominal radical hysterectomy (ARH) [6][7][8][9] . A retrospective analysis of 60 patients with early cervical cancer conducted by Zakashansky et al [10] showed that in this cohort, no conversion to laparotomy appeared; the intraoperative blood loss was only 200 mL, far less than 520 mL in ARH; there was no intraoperative blood transfusion compared to 5 cases (5/30) of intraoperative blood transfusion in laparotomy; the average hospital stay in TRLH was 1.8 days, shorter than that in ARH; however, the operative time lasted 318.5 min in TRLH, significantly longer than 242.5 min in ARH. Some scholars believed that the longer operative time in TRLH group is related to the proficiency of surgical skill [9,11,12] and the selection and use of surgical devices [13,14] .…”

Use of laparoscopic modified nerve-sparing radical hysterectomy for the treatment of extensive endometriosis

“…The recurrence rate of endometriosis after radical surgical treatment reported is approximately 3% [27][28]. All patients in this study, some with long-term follow-up (average follow-up 32 months with a range of 1-65 months), experienced significant pain relief after hysterectomy.…”

Surgical Treatment of Early-Stage Cervical Cancer

“…Other studies have concluded that the laparoscopic, or laparoscopic-assisted vaginal radical hysterectomy results in less overall morbidity, less blood loss, fewer transfusions, a shorter hospitalization (by 3 days), a longer surgical time, and equal recurrence rates as compared to the classical open management [32,33,34,35,36]. The only prospective randomized study published so far dealing with such a comparison looked at small FIGO IB tumors, with only 15 patients who were randomized to either laparoscopic-assisted vaginal radical hysterectomy or radical abdominal hysterectomy.…”