Total laparoscopic radical hysterectomy and lymphadenectomy: The M. D. Anderson Cancer Center Experience
Introduction
Total laparoscopic radical hysterectomy was described initially by Canis et al. [1] and Nezhat et al. [2]. Since those initial reports, a number of other groups have published their experiences showing the feasibility and safety of this procedure [3], [4], [5], [6], [7], [8]. These experiences have also suggested that performing the procedure laparoscopically does not adversely affect the patient's overall prognosis and survival [3], [4], [5], [6], [7], [8]. Nevertheless, few long-term data are available on the morbidity of laparoscopic radical hysterectomy and survival after this procedure.
The purpose of this study was to evaluate the feasibility and morbidity of total laparoscopic radical hysterectomy performed at The University of Texas M. D. Anderson Cancer.
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Materials and methods
The medical records of all patients who underwent total laparoscopic radical hysterectomy and lymphadenectomy at M.D. Anderson Cancer Center between May 2004 and August 2005 were reviewed. Institutional Review Board approval was obtained. Data were obtained from medical and pathologic records. All patients entered on the study had their initial pathologic diagnosis confirmed at our institution.
The patient characteristics retrieved were age, body mass index, stage of disease according to the
Results
Twenty patients underwent total laparoscopic radical hysterectomy at M. D. Anderson between May 2004 and August 2005. None of the surgeries required conversion to a laparotomy. No procedures were aborted secondary to evidence of microscopically or macroscopically positive lymph nodes or extracervical disease. Four patients underwent lymphatic mapping and sentinel node biopsy.
The median patient age was 41.5 years (range, 25–76). Eighteen patients had cervix cancer (5 had stage IA2 and 13 stage
Discussion
Our experience shows that total laparoscopic radical hysterectomy is feasible and safe and is associated with a significant lower morbidity rate than the rates reported in the literature for open radical hysterectomy. To date, no randomized trials have been performed comparing laparoscopic and open radical hysterectomy. The largest series thus far on laparoscopic radical hysterectomy, by Spirtos et al. [9], describes 78 consecutive patients, all with early cervical cancer. In that series, 94%
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