Clinical evaluation of laparoscopic-assisted radical vaginal hysterectomy with pelvic and/or paraaortic lymphadenectomy.

Abstract Study Objective To report our experience with radical laparoscopic-assisted vaginal hysterectomy (LAVH) with bilateral pelvic and/or paraaortic lymphadenectomy. Design Retrospective review (Canadian Task Force classification III). Setting University-affiliated hospital. Patients Fifty-two women with invasive carcinoma of the cervix, stage Ib1, smaller than 3 cm. Intervention Radical LAVH with pelvic and/or paraaortic lymphadenectomy. Measurements and Main Results Total operating time ranged from 230 to 650 minutes (mean 380 min). Major surgical complications were two cases of ureter injury, two cases of ureteral stricture, and one case of hematoma at the cannula site. Two cases were converted to laparotomy due to incomplete hemostasis of the uterine artery and obturator vein. The mean hemoglobin decrement was 1.7 g/dl the day after operation. Thirty patients received blood transfusion (mean 1.8 pints). Average numbers of pelvic and paraaortic lymph nodes removed were 27.7 (range 9–63) and 22.1 (range 6–52), respectively. After surgery, patients passed gas in 2.2 days and self-voided in 18.4 days on average. One woman had pelvic recurrence at 26 months after surgery. One died from brain metastasis 10 months after surgery. Conclusion This technique is feasible for treatment of early cervical carcinoma. An experienced surgeon could shorten operating time and reduce complications.