From laparoscopic assisted radical vaginal hysterectomy to vaginal assisted laparoscopic radical hysterectomy

Koehler, Christhardt; Gottschalk, E; Chiàntera, Vito; Marnitz, Simone; Hasenbein, Kati; Schneider, Achim

doi:10.1111/j.1471-0528.2011.03202.x

Cited by 30 publications

(23 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Despite some reservations regarding manipulator application,29 it has been widely used and considered safe among most gynecologic oncologists 6 30. In contrast, our group has established a surgical technique combining a laparoscopic and vaginal approach,14 in which we never used any uterine manipulator and always created a tumor-covering vaginal cuff transvaginally.…”

Section: Discussionmentioning

confidence: 99%

“…Despite encouraging oncologic results,16 we had to modify this approach due to a peri- and post-operative urologic complication rate of >10% and difficulty in passing the learning curve. From 2005 up to now the technique of vaginal-assisted laparoscopic radical hysterectomy14 has been used. Both techniques have already been described in detail 4 14.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff – a multicenter analysis

Köhler

Hertel

Herrmann

et al. 2019

Int J Gynecol Cancer

153

View full text Add to dashboard Cite

ObjectiveLaparoscopic/robotic radical hysterectomy has been historically considered oncologically equivalent to open radical hysterectomy for patients with early cervical cancer. However, a recent prospective randomized trial (Laparoscopic Approach to Cervical Cancer, LACC) has demonstrated significant inferiority of the minimally invasive approach. The aim of this study is to evaluate the oncologic outcomes of combined laparoscopic-vaginal radical hysterectomy.MethodsBetween August 1994 and December 2018, patients with invasive cervical cancer were treated using minimally-invasive surgery at the Universities of Jena, Charité Berlin (Campus CCM and CBF) and Cologne and Asklepios Clinic Hamburg. 389 patients with inclusion criteria identical to the LACC trial were identified. In contrast to the laparoscopic/robotic technique used in the LACC trial, all patients in our cohort underwent a combined transvaginal-laparoscopic approach without the use of any uterine manipulator.ResultsA total of 1952 consecutive patients with cervical cancer were included in the analysis. Initial International Federation of Gynecology and Obstetrics (FIGO) stage was IA1 lymphovascular space invasion (LVSI+), IA2 and IB1/IIA1 in 32 (8%), 43 (11%), and 314 (81%) patients, respectively, and histology was squamous cell in 263 (68%), adenocarcinoma in 117 (30%), and adenosquamous in 9 (2%) patients. Lymphovascular invasion was confirmed in 106 (27%) patients. The median number of lymph nodes was 24 (range 2–86). Lymph nodes were tumor-free in 379 (97%) patients. Following radical hysterectomy, 71 (18%) patients underwent adjuvant chemoradiation or radiation. After a median follow-up of 99 (range 1–288) months, the 3-, 4.5-, and 10-year disease-free survival rates were 96.8%, 95.8%, and 93.1 %, and the 3-, 4.5-, and 10-year overall survival rates were 98.5%, 97.8%, and 95.8%, respectively. Recurrence location was loco-regional in 50% of cases with recurrence (n=10). Interestingly, 9/20 recurrences occurred more than 39 months after surgery.ConclusionThe combined laparoscopic-vaginal technique for radical hysterectomy with avoidance of spillage and manipulation of tumor cells provides excellent oncologic outcome for patients with early cervical cancer. Our retrospective data suggest that laparoscopic-vaginal surgery may be oncologically safe and should be validated in further randomized trials.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff – a multicenter analysis

Köhler

Hertel

Herrmann

et al. 2019

Int J Gynecol Cancer

153

View full text Add to dashboard Cite

show abstract

“…The last 20 years have validated a growing number of reports and a broad clinical and research interest in minimally invasive surgery for the management of early cervical cancer [30]. Equivalent oncologic outcomes and reduced peri-operative morbidity are observed in retrospective trials comparing laparoscopic or robotic-assisted approaches versus laparotomy [31].…”

Section: Single-port Radical Hysterectomy For Cervical Cancermentioning

confidence: 98%

Laparoendoscopic single-site hysterectomy

Fanfani

Monterossi

Fagotti

et al. 2014

Current Opinion in Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

show abstract

“…Our surgical techniques of the two radical operations have been described previously [18,19]. Both operations always start with the removal of pelvic lymph nodes and frozen section thereof.…”

Section: Methodsmentioning

confidence: 99%

Validity of Laparoscopic Staging to Avoid Adjuvant Chemoradiation following Radical Surgery in Patients with Early Cervical Cancer

Marnitz

Köhler²,

Affonso³

et al. 2012

Oncology

View full text Add to dashboard Cite

Purpose: To determine the rate of unavoidable adjuvant chemoradiation (RCTX) due to histologic results after radical surgery in patients with early cervical cancer. Patients and Methods: Between May 2004 and July 2011, 448 consecutive patients diagnosed with invasive cervical cancer stage IA1 L1 to IIA underwent laparoscopic staging at the Department of Gynecology and Gynecologic Oncology at Charité Berlin. Only in patients without lymph node metastases (n = 394) on frozen section, radical operation was continued either by laparoscopic radical hysterectomy (n = 228) or by radical vaginal trachelectomy (n = 166). The decision for adjuvant RCTX was reached among the members of an interdisciplinary tumor board according to the presence of risk factors. The mean age of patients was 39 years. Squamous cell cancer was found in 62.5%, adenocarcinoma in 32.7%, adenosquamous cancer in 3.8% and others in 1% of patients. Adjuvant treatment was indicated if at least one category 1 risk factor (pN1, R1 or RX, parametrial involvement) and/or any combination of category 2 risk factors (lymphovascular space involvement (LVSI), hemovascular space involvement, grading 3, young age, deep stromal invasion, large tumor size) were present. Results: In 39 of 394 patients (9.9%), adjuvant RCTX was recommended due to category 1 risk factors (n = 25/6.4%) and category 2 risk factors (n = 14/3.5%). Tumor-involved (R0) or unclear resection margins (RX) were present in 4 (1%) and 1 (0.3%), parametrial involvement in 12 (3%) and positive lymph nodes in 11 (2.8%) patients, respectively. Hemovascular involvement was found in 14 (3.5%), LVSI in 113 (28.7%) and grading 3 in 122 (31%) patients, respectively. Conclusion: Laparoscopic staging is a reliable tool to keep the rate of tri-modal (surgery + chemotherapy + radiotherapy) treatments in patients with cervical cancer stage I and IIA after radical surgery at 10%. This percentage should be used as benchmark for the quality of interdisciplinary treatment of patients diagnosed with cervical cancer.

show abstract

From laparoscopic assisted radical vaginal hysterectomy to vaginal assisted laparoscopic radical hysterectomy

Cited by 30 publications

References 47 publications

Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff – a multicenter analysis

Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff – a multicenter analysis

Laparoendoscopic single-site hysterectomy

Validity of Laparoscopic Staging to Avoid Adjuvant Chemoradiation following Radical Surgery in Patients with Early Cervical Cancer

Contact Info

Product

Resources

About