Duplication of Conventional Multiport Laparoscopic Radical Hysterectomy Steps with Other Minimal Access Modalities (LESS, OASIS, Robotic).

Abstract Study Objective To duplicate the steps of conventional multiport laparoscopic radical hysterectomy by 3 other minimal access modalities: robotic radical hysterectomy, laparoendoscopic single-site surgery (LESS), and orifice-assisted small-incision surgery (OASIS). Design Institutional Review Board approval was obtained. Between January 2009 and December 2012, the charts of the patients who had undergone radical hysterectomy by these 4 minimal access modalities were analyzed. Setting Galaxy Care Laparoscopy Institute, Pune, India. Patients Fifteen patients in each arm with stage IB1 cervical cancer with a histopathological report of squamous cell carcinoma were analyzed. All patients had undergone radical hysterectomy by a conventional multiport, robotic, LESS, or OASIS technique. The type of procedure was decided by joint consultancies of doctor and patient.Operative modalitySelection criteriaOASISUterine size less than 10 weeksNo previous vaginal surgeryNo history of pelvic inflammatory diseaseBody mass index (BMI)  30Selection of robotic and multiport was according to payment ability of patient All patients were analyzed retrospectively for time, blood loss, oncologic clearance, and complications. The median follow-up of all patients was 12 months (range, 8–18 months). Intervention The "Pune technique" of radical hysterectomy consists of 6 steps: (1) posterior U cut; (2) dissection of pouch of Douglas; (3) pararectal space dissection; (4) anterior U cut; (5) uretric tunnel dissection; and (6) ilio-obturator lymph node dissection. Measurements and Results VariableMultiport laparoscopic radical hysterectomyRobotic radical hysterectomyLESSOASISOperative time, min (mean)114128140162Lymph node retrieval (mean)22281618Parametrium, cm (mean)3.53.252.252.75Estimated blood loss, mL (mean)130102225212 Conclusion The radical hysterectomy is a type B radical hysterectomy. Proper patient selection plays an important role in radical hysterectomy with different minimal access operative modalities. Parametrium clearance of 2.25 to 3.5 cm can be obtained with different modalities [1-5]. As of the writing of this report, none of the 60 patients evaluated had experienced recurrence, and all are disease-free. The study period was 4 years. To conclude, our data indicate that the steps of conventional multiport radical hysterectomy by the Pune technique can be duplicated by other minimal access modalities, including robotic radical hysterectomy, LESS, and OASIS.