A simple technique of vaginal cuff closure to prevent tumor cell spillage in laparoscopic radical hysterectomy for uterine cervical cancer

Abstract

Introduction The Laparoscopic Approach to Cervical Cancer (LACC) trial, a prospective randomized phase III clinical trial reported in 2018, unexpectedly showed inferior oncologic outcomes in laparoscopic radical hysterectomy (LRH) for cervical cancer compared with those in open surgery. It was proposed that the spillage of tumor cells into the peritoneal cavity might cause the inferiority of LRH. It has been suggested, based on retrospective studies, that transvaginal closure of the vaginal cuff before the colpotomy part of the surgery may prevent this. Materials and Surgical Technique Before starting colpotomy, we closed the vaginal cuff transvaginally. After the assessment of the cutline of the vagina, the vaginal mucosa is pulled at the eight sites using the sutures. The four pairs of sutures on the diagonal line are ligated. A purse string suture is additionally placed on the vaginal mucosa to close the vaginal cuff completely. After that, we start the intracorporeal colpotomy using a vaginal pipe. Discussion Our technique is simple and quick. The blood loss during the transvaginal procedures is minimal. The use of the vaginal pipe helps keep the vaginal cuff closed during the colpotomy. Our technique may be an alternative to the conventional approach closing the vaginal cuff.

R0 resection of vaginal stump recurrence of gynecologic malignancy by bi‐directional endoscopic approach: A case series of four patients

“…Instead, we paid attention to the following procedures: (1) inactivation of vaginally exposed tumor cells with iodine; 7 (2) no‐touch manipulation under pneumovaginoscopic clear vision; (3) abdominal cavity and vagina were thoroughly cleaned with 500 mL of normal saline after stump resection, but before re‐suturing the vaginal stump. These might have prevented tumor cell spillage, 10 and as a result, we have not observed any postoperative recurrence in all the four cases.…”

“…Tumor wrapping by creating a vaginal cuff could be a useful technique to prevent tumor spillage. 10 However, after suture-closure of the vaginal cuff, precise resection without rupturing the vaginal cuff is not always easy, partly because of postoperative adhesion to the surrounding organs, including bladder, ureters, and rectum, anatomical changes around the vaginal stump after primary operation, and patient characteristics, such as narrow vagina and obesity. Thus, we did not create a vaginal cuff for the cases in this series.…”

Laparo-assisted vaginal radical hysterectomy as a safe option for minimal invasive surgery in early stage cervical cancer: A systematic review and meta-analysis

“…The laparoscopic staging, integrated with the vaginal creation of a tumor-adapted covering cuff, combine the advantages of MIS and open approaches. Following this principle, it has been declined in different variations [14,[40][41][42]. Other studies proved the hypothesis that LARVH prevents tumor cells' spillage [43].…”

Robotic radical abdominal trachelectomy in early-stage cervical cancer: safe removal of the cervix with underpressure colpotomizer – review report based on case study

“…This can also be an alternative method [43]. The similar solution was described by Deura et al [44].…”