Total laparoscopic radical hysterectomy with pelvic lymphadenectomy using the argon-beam coagulator: pilot data and comparison to laparotomy

Abstract

Objectives

The aim of this study was to describe the feasibility and outcome of total laparoscopic radical hysterectomy with pelvic lymphadenectomy for stage I cervical cancer using the argon-beam coagulator.

Methods

A retrospective review was performed of patients with FIGO stage IA1–IB1 cervical cancer who underwent a total laparoscopic approach for definitive surgical treatment. Comparison was made to a cohort of 195 patients who were treated with laparotomy.

Results

Between 12/2000 and 12/2002, 19 patients were offered the laparoscopic approach. The procedure was completed laparoscopically in 17 patients (89.5%). Two patients, in the beginning of the study, underwent conversion to laparotomy, 1 due to parametrial bleeding and 1 due to pelvic adhesions and cystotomy. Mean age was 42.6 years (range, 30–69 years); mean body mass index was 23.1 (range, 18–30); FIGO stage included IA1 with LVI (2), IA2 (6), IB1 (11). Mean pelvic lymph node count was 25.5 (range, 15–39), and 1 patient (5.3%) had positive nodes. Mean estimated blood loss was 301 cc (range, 75–1500 cc) compared to 693 cc in the laparotomy group (P < 0.01), mean operating time was 371 min (range, 230–600 min) compared to 295 min in the laparotomy group (P < 0.01), and mean hospital stay was 4.5 days (range, 3–11 days) compared to 9.7 days in the laparotomy group (P < 0.01). There were no ureteral injuries or fistula formation. All patients remain clinically disease free at the time of this report.

Conclusions

Total laparoscopic radical hysterectomy with pelvic lymphadenectomy for selected patients with stage I cervical cancer is feasible, safe, and associated with a low morbidity in the pilot phase. Estimated blood loss and postoperative hospitalization appear shorter than historical controls, at the cost of longer operating time. Oncologic outcome requires longer follow-up.

Introduction

Advanced operative laparoscopic procedures for gynecologic malignancies continue to be developed and modified in an attempt to approach these diseases using minimally invasive techniques. Total laparoscopic radical hysterectomy with pelvic and/or aortic lymph node dissection, a technically challenging procedure, was initially received with caution by the gynecologic oncology community in the United States, which for decades utilized the abdominal radical hysterectomy. There are no randomized trials to compare these two surgical approaches, and it is unlikely that a randomized trial will be undertaken in the near future—most likely due to the limited availability of this procedure in most medical centers and the inability of a single institution to complete a randomized trial. Like most other advanced laparoscopic approaches in oncology, there is always concern about adopting these procedures and replacing the traditional approach; in addition, there is uncertainty over pilot results, equivalency of surgical yield, complications during the initial phase of the learning curve, effects on patient recovery, and overall oncologic outcome. We sought to describe our initial experience with total laparoscopic radical hysterectomy and pelvic lymphadenectomy for cervical cancer and compare patient characteristics and surgical parameters to a control group treated by the traditional surgical approach.