Minilaparoscopic radical hysterectomy (mLPS-RH) vs laparoendoscopic single-site radical hysterectomy (less-rh) in early stage cervical cancer

A multicenter retrospective study

Anna Fagotti, Fabio Ghezzi, David M. Boruta, Giovanni Scambia, Pedro Escobar, Amanda N. Fader, Mario Malzoni, Francesco Fanfani

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Study Objective: To compare the perioperative outcomes of laparoendoscopic single-site radical hysterectomy (LESS-RH) and minilaparoscopic radical hysterectomy (mLPS-RH). Design: Retrospective study (Canadian Task Force classification II-2). Setting: Seven institutions in Italy. Patients: Forty-six patents with early cervical cancer (FIGO stage IA2-IB1/IIA1) were included in the study. Nineteen patients (41.3%) underwent LESS-RH, and 27 (58.7%) underwent mLPS-RH. Pelvic lymph node dissection was performed in all patients. Interventions: In the LESS-RH group, all surgical procedures were performed through a single umbilical multichannel port. In the mLPS-RH group, the procedure was completed using a 5-mm umbilical optical trocar and 3 additional 3-mm ancillary trocars, placed suprapubically and in the left and right lower abdominal regions. Measurements and Main Results: There was no difference in clinicopathologic characteristics at the time of diagnosis between the LESS-RH and mLPS-RH groups. Median operative time was 270minutes (range, 149-380minutes) for LESS-RH, and was 180minutes (range, 90-240minutes) for mLPS-RH (p=.001). No further differences were detected between the 2 groups insofar as type of radical hysterectomy, number of lymph nodes removed, or perioperative outcomes. In the LESS-RH group, conversion to laparotomy was necessary in 1 patient (5.3%) because of external iliac vein injury, and in another patient, conversion to standard laparoscopy was required because of truncal obesity. In the mLPS-RH group, no conversions were observed; however, a repeat operation was performed to repair a ureteral injury. The percentage of patients discharged 1day after surgery was significantly higher in the LESS-RH group (57.9%) compared with the mLPS-RH group (25.0%) (p=.03). After a median follow-up of 27months (range, 9-73months), only 1 patient, who had undergone mLPS-RH, experienced pelvic recurrence and died of the disease. Conclusions: Both LESS-RH and mLPS-RH are feasible ultra-minimally invasive approaches for performance of radical hysterectomy plus pelvic lymph node dissection. Further technical improvements are required to enable wider use of these techniques for more complex procedures.

Original languageEnglish
Pages (from-to)1005-1009
Number of pages5
JournalJournal of Minimally Invasive Gynecology
Volume21
Issue number6
DOIs
Publication statusPublished - 2014

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Hysterectomy
Uterine Cervical Neoplasms
Multicenter Studies
Retrospective Studies
Umbilicus
Lymph Node Excision
Surgical Instruments
Iliac Vein
Patents
Wounds and Injuries
Advisory Committees
Operative Time

Keywords

  • Early-stage cervical cancer
  • Laparoendoscopic single-site surgery
  • Minilaparoscopic surgery
  • Radical hysterectomy

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Medicine(all)

Cite this

Minilaparoscopic radical hysterectomy (mLPS-RH) vs laparoendoscopic single-site radical hysterectomy (less-rh) in early stage cervical cancer : A multicenter retrospective study. / Fagotti, Anna; Ghezzi, Fabio; Boruta, David M.; Scambia, Giovanni; Escobar, Pedro; Fader, Amanda N.; Malzoni, Mario; Fanfani, Francesco.

In: Journal of Minimally Invasive Gynecology, Vol. 21, No. 6, 2014, p. 1005-1009.

Research output: Contribution to journalArticle

Fagotti, Anna ; Ghezzi, Fabio ; Boruta, David M. ; Scambia, Giovanni ; Escobar, Pedro ; Fader, Amanda N. ; Malzoni, Mario ; Fanfani, Francesco. / Minilaparoscopic radical hysterectomy (mLPS-RH) vs laparoendoscopic single-site radical hysterectomy (less-rh) in early stage cervical cancer : A multicenter retrospective study. In: Journal of Minimally Invasive Gynecology. 2014 ; Vol. 21, No. 6. pp. 1005-1009.
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abstract = "Study Objective: To compare the perioperative outcomes of laparoendoscopic single-site radical hysterectomy (LESS-RH) and minilaparoscopic radical hysterectomy (mLPS-RH). Design: Retrospective study (Canadian Task Force classification II-2). Setting: Seven institutions in Italy. Patients: Forty-six patents with early cervical cancer (FIGO stage IA2-IB1/IIA1) were included in the study. Nineteen patients (41.3{\%}) underwent LESS-RH, and 27 (58.7{\%}) underwent mLPS-RH. Pelvic lymph node dissection was performed in all patients. Interventions: In the LESS-RH group, all surgical procedures were performed through a single umbilical multichannel port. In the mLPS-RH group, the procedure was completed using a 5-mm umbilical optical trocar and 3 additional 3-mm ancillary trocars, placed suprapubically and in the left and right lower abdominal regions. Measurements and Main Results: There was no difference in clinicopathologic characteristics at the time of diagnosis between the LESS-RH and mLPS-RH groups. Median operative time was 270minutes (range, 149-380minutes) for LESS-RH, and was 180minutes (range, 90-240minutes) for mLPS-RH (p=.001). No further differences were detected between the 2 groups insofar as type of radical hysterectomy, number of lymph nodes removed, or perioperative outcomes. In the LESS-RH group, conversion to laparotomy was necessary in 1 patient (5.3{\%}) because of external iliac vein injury, and in another patient, conversion to standard laparoscopy was required because of truncal obesity. In the mLPS-RH group, no conversions were observed; however, a repeat operation was performed to repair a ureteral injury. The percentage of patients discharged 1day after surgery was significantly higher in the LESS-RH group (57.9{\%}) compared with the mLPS-RH group (25.0{\%}) (p=.03). After a median follow-up of 27months (range, 9-73months), only 1 patient, who had undergone mLPS-RH, experienced pelvic recurrence and died of the disease. Conclusions: Both LESS-RH and mLPS-RH are feasible ultra-minimally invasive approaches for performance of radical hysterectomy plus pelvic lymph node dissection. Further technical improvements are required to enable wider use of these techniques for more complex procedures.",
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AU - Ghezzi, Fabio

AU - Boruta, David M.

AU - Scambia, Giovanni

AU - Escobar, Pedro

AU - Fader, Amanda N.

AU - Malzoni, Mario

AU - Fanfani, Francesco

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N2 - Study Objective: To compare the perioperative outcomes of laparoendoscopic single-site radical hysterectomy (LESS-RH) and minilaparoscopic radical hysterectomy (mLPS-RH). Design: Retrospective study (Canadian Task Force classification II-2). Setting: Seven institutions in Italy. Patients: Forty-six patents with early cervical cancer (FIGO stage IA2-IB1/IIA1) were included in the study. Nineteen patients (41.3%) underwent LESS-RH, and 27 (58.7%) underwent mLPS-RH. Pelvic lymph node dissection was performed in all patients. Interventions: In the LESS-RH group, all surgical procedures were performed through a single umbilical multichannel port. In the mLPS-RH group, the procedure was completed using a 5-mm umbilical optical trocar and 3 additional 3-mm ancillary trocars, placed suprapubically and in the left and right lower abdominal regions. Measurements and Main Results: There was no difference in clinicopathologic characteristics at the time of diagnosis between the LESS-RH and mLPS-RH groups. Median operative time was 270minutes (range, 149-380minutes) for LESS-RH, and was 180minutes (range, 90-240minutes) for mLPS-RH (p=.001). No further differences were detected between the 2 groups insofar as type of radical hysterectomy, number of lymph nodes removed, or perioperative outcomes. In the LESS-RH group, conversion to laparotomy was necessary in 1 patient (5.3%) because of external iliac vein injury, and in another patient, conversion to standard laparoscopy was required because of truncal obesity. In the mLPS-RH group, no conversions were observed; however, a repeat operation was performed to repair a ureteral injury. The percentage of patients discharged 1day after surgery was significantly higher in the LESS-RH group (57.9%) compared with the mLPS-RH group (25.0%) (p=.03). After a median follow-up of 27months (range, 9-73months), only 1 patient, who had undergone mLPS-RH, experienced pelvic recurrence and died of the disease. Conclusions: Both LESS-RH and mLPS-RH are feasible ultra-minimally invasive approaches for performance of radical hysterectomy plus pelvic lymph node dissection. Further technical improvements are required to enable wider use of these techniques for more complex procedures.

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