Vaginal-Assisted Laparoscopic Radical Hysterectomy: Rationale, Technique, Results

Abstract

The authors conclude that vaginal-assisted laparoscopic radical hysterectomy is an oncologic viable alternative to abdominal radical hysterectomy, laparoscopic-assisted radical vaginal hysterectomy, totally laparoscopic radical hysterectomy, and robotic radical hysterectomy.

Patterns of recurrence and survival after abdominal versus laparoscopic/robotic radical hysterectomy in patients with early cervical cancer

“…In the literature, many gynecologic oncologists have suggested several different techniques to perform laparoscopic radical hysterectomy (LRH), including laparoscopicassisted radical vaginal hysterectomy (LARVH), total laparoscopic RH (TLRH), laparoscopic-vaginal RH (LVRH) and vaginal-assisted laparoscopic RH (VALRH). [1][2][3][4][5][6][7][8][9][10][11][12] Recently, total robotic radical hysterectomy (TRRH) has rapidly emerged as an alternative minimally invasive method. [13][14][15][16] The advantages of minimally invasive surgery (MIS) for treating cancerous tumors are: less trauma, better visualization, less blood loss and short hospital stays and convalescence, while its drawbacks include the risk of potential spread of cancerous cells.…”

Peritoneal contamination with ICG‐stained cervical secretion as surrogate for potential cervical cancer tumor cell dissemination: A proof‐of‐principle study for laparoscopic hysterectomy

“…This observation points to increased peritoneal dissemination during laparoscopic surgery. Schneider et al emphasized that vaginal colpotomy is essential to prevent peritoneal tumor dissemination . Therefore, a vaginal cuff is formed to cover the cervix completely and prevent potential tumor spillage.…”

“…1,8,9,[14][15][16][17][18] Some findings indicate a prognostic role of tumor cell spillage potomy is essential to prevent peritoneal tumor dissemination. [6][7][8] Therefore, a vaginal cuff is formed to cover the cervix completely Other experts criticize the frequent use of uterine manipulators during laparoscopic radical hysterectomy. In a histopathologic analysis, Rakowski et al 19 could not detect differences regarding tumor histology between cases in which a manipulator was used and those without manipulator.…”

“…Several mechanisms have been proposed which might explain these findings. Increased intraoperative tumor cell dissemination during laparoscopy is one of the most frequently discussed theories . The frequent use of uterine manipulators might present an additional factor for tumor dissemination .…”

“…Increased intraoperative tumor cell dissemination during laparoscopy is one of the most frequently discussed theories. [7][8][9] The frequent use of uterine manipulators might present an additional factor for tumor dissemination. 1 Other suggestions deal with the tumor-promoting influence of CO 2 pneumoperitoneum or the less radical surgical approach by laparoscopic surgery.…”