Learning Curve of Laparoscopic Radical Hysterectomy With Pelvic and/or Para-Aortic Lymphadenectomy in the Early and Locally Advanced Cervical Cancer

Chong, Gun Oh; Park, Nae Yoon; Hong, Dae Gy; Cho, Young Lae; Park, Il Soo; Lee, Yoon Soon

doi:10.1111/igc.0b013e3181b76640

Cited by 77 publications

(75 citation statements)

References 23 publications

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“…In this regard were grouped top 50 and next 50 hysterectomies. Authors concluded that all of the aforementioned parameters were improved in group 2 [17]. Similar results were published by Hwang et al for uterine cervical cancer in the early stages who received laparoscopic radical hysterectomy with lymphadenectomy.…”

Section: Laparoscopic and Robotic Learning Curve Technique In Gynecolsupporting

confidence: 75%

Minimally Invasive Surgery: A New Approach for Uterine Cervical Cancer

Gavrilescu¹,

Todosi²,

Ioanid³

et al. 2015

Surgery

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IntroductionIn the early 1990s, the laparoscopic approach in uterine cervical cancer has started to become quite popular among oncologist surgeons in order to minimize postoperative morbidity. When a new surgical technique is taken into consideration or suggested, it is compared with the standard therapy hitherto. Important issues to be taken into account include the feasibility and applicability of the new technique, intraoperative and postoperative complications and in oncological cases, survival and risk of recurrence.Gold standard for uterine cervical cancer in the early stages was abdominal radical hysterectomy with pelvic lymphadenectomy for more than 100 years. This technique, described for the first time Wertheim, Meigs subsequently underwent some changes. The first laparoscopic hysterectomy was performed and published in 1989 [1], but the first laparoscopic radical hysterectomy with pelvic and paraaortic lymphadenectomy in a patient with cervical cancer stage IA2 was performed by Nezha et al. in June 1989 and reported in 1992 [2]. Since then, it has been reported in the literature over 1000 cases [3]. Laparoscopic Surgery versus Open Surgery in Uterine Cervical CancerInitially used for diagnostic, laparoscopy has become a method of treatment in the field of gynecological surgery, but also in many other field. The results of laparoscopic surgery are now comparable with those obtained by laparotomy in benign and malignant pathologies. The most important advantages of the laparoscopic technique include more pleasing cosmetic appearance, or minimum parietal infectious complications, low incidence of adhesion formation, low cost associated with hospitalization and recovery period smaller resumption of daily activities in a shorter period [4]. In a study comparing the two surgical techniques, the results show an average of operating time with significant differences statistically 231.7 minutes for cases treated laparoscopically and 207 minutes to classical surgery, which can be explained by the fact that laparoscopic hysterectomies implemented quite recently requires a learning curve. The surgeons will become more familiar with laparoscopic procedure; the operative time is expected to become shorter. Intraoperative blood loss was lower in the laparoscopy (161.1 ml) compared with the traditional method (394.4 ml), with blood transfusions in 3 patients. Postoperative complications, represented mostly wound infections were recorded only in the group that received radical abdominal hysterectomy. The hospital stay was less in laparoscopic interventions (mean=2.9 days) compared with the second procedure (mean=5. A randomized, multicenter study including 116 patients demonstrated that laparoscopic assisted vaginal hysterectomy can be performed in a similar operating time classic surgery with intraoperative blood loss less and a relatively shorter period of hospitalization (p<0.01). Postoperative pain, another important parameter discussed, is lower for the first 3 days of laparoscopy versus open surgery (p<0.5) [7]....

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Section: Laparoscopic and Robotic Learning Curve Technique In Gynecolsupporting

confidence: 75%

Minimally Invasive Surgery: A New Approach for Uterine Cervical Cancer

Gavrilescu¹,

Todosi²,

Ioanid³

et al. 2015

Surgery

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“…In addition, the movement of the robotic arm results in stable traction and counter traction and excellent 3-dimensional view within a narrow space. 19,22 A recent meta-analysis revealed that the blood loss in the RRH group can be as low as 78 or 82 mL. 16,35,36 In our study, the mean blood loss was much higher compared with those studies but was still significantly lower in the RRH group versus the TLRH group.…”

Section: International Journal Of Gynecologicalcontrasting

confidence: 51%

Robotic-Assisted Radical Hysterectomy Results in Better Surgical Outcomes Compared to the Traditional Laparoscopic Radical Hysterectomy for the Treatment of Cervical Cancer

Nie

Liu

2017

Journal of Minimally Invasive Gynecology

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Objective: The aim of this study was to compare the surgical outcomes of robotic-assisted radical hysterectomy (RRH) with traditional laparoscopic radical hysterectomy (TLRH) for the treatment of early-stage cervical cancer in a large retrospective cohort of a total of 933 patients. Methods: We have enrolled 100 patients into the RRH and 833 patients into the TLRH group. The surgical outcomes include operating time, blood loss, transfusion rate, pelvic lymph node yield, hospitalization days, duration of bowel function recovery, catheter removal before and after 3 weeks, conversion to laparotomy, and intraoperative and postoperative complications. Follow-up results were also analyzed for all patients. Results: Both groups have similar patient and tumor characteristics but patients with a larger lesion size were preferably enrolled in the TLRH treatment group. The treatment with RRH was generally superior to TLRH with respect to operating time, blood loss, length of hospitalization, duration of bowel function recovery, and postoperative complications. On follow-up of patients, there were no relapses reported in the RRH group compared with 4% of relapse cases and 2.9% of deaths because of metastasis in the TLRH group. No conversion of laparotomy occurred in the RRH group. No significant difference was found with respect to intraoperative complications and blood transfusion between both groups. Conclusions: The results from this study suggest that RRH is superior to TLRH with regard to surgical outcome and may pose a safe and feasible alternative to TLRH. The operating time and lymph node yield is acceptable. Our study is one of the largest single-center studies of surgical outcomes comparing RRH with TLRH during cervical cancer treatment and will significantly contribute to the safety of alternative treatment options for patients. Furthermore, the difference detected between TLRH and RRH group is further strengthened by the great expertise of the surgeon performing laparoscopic surgeries.

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“…In open surgery, as the difficulties of operations increase, the probability of ureteral injury increases by 0-2.0% (Uccella et al, 2007;Chong et al, 2009), whereas the probability of ureteral injury in laparoscopic operations increases by 0.2-6.0% (Cholkeri-Singh et al, 2007;Tanaka et al, 2008). This increased risk is due to the limitations of visual exposure, the lack of touch, and the use of an energy apparatus.…”

Section: Discussionmentioning

confidence: 99%

“…As laparoscopic hysterectomy and retroperitoneal operations, such as pelvic lymph node dissections, have increasingly been adopted, the occurrence rate of laparoscopic ureteral injury has also increased (Cholkeri-Singh et al, 2007;Tanaka et al, 2008). Furthermore, the rate of ureteral injuries resulting from laparoscopic operations is substantially higher than that resulting from celiotomies (Uccella et al, 2007;Chong et al, 2009). Ureteral injury results in not only increased medical expenses, but also increased physical and emotional damage for patients.…”

Section: Introductionmentioning

confidence: 99%

Preset ureter catheter in laparoscopic radical hysterectomy of cervical cancer

Han¹,

Cao²,

Jiang³

et al. 2014

Genet. Mol. Res.

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ABSTRACT. The aim of this study was to evaluate the clinical efficacy of a temporary ureteral catheter in preventing iatrogenic ureteral damage in cervical cancer patients undergoing laparoscopic radical hysterectomy. All cases had confirmed diagnoses of cervical cancer preoperatively between December 2008 and December 2012 in our hospital and were in clinical stages IA2 to IIA. In total, 176 laparoscopic radical hysterectomy and lymphadenectomy procedures were performed. The 176 cases were divided into two groups: ureteral catheters were installed using cystoscopy before the operation in 86 patients (group A), and ureteral catheters were not placed in 90 patients (group B). These cases were retrospectively analyzed based on postoperative hospitalization time and intraoperative and postoperative complications. A total of 6 cases (3.41%) had ureteral injuries, and 4 of the cases (4.65%) of ureteral injuries occurred in group A. In two of these cases, urinary leaking appeared at the post-operative 8th and 9th days and at the 10th and 25th days, respectively. There were 2 cases (2.22%) of ureteral injuries in group B: 1 case of intraoperative direct Laparoscopic radical hysterectomy of cervical cancer injury and the other of urinary leaking, which appeared at post-operative day 21. Statistically significant differences between the two groups were observed in operating time and the incidence of hemorrhage, hematuria (including microscopic hematuria), post-operative urinary tract infection, and pain (P < 0.05). A ureteral catheter that is placed preoperatively can help to identify the ureter in laparoscopic radical hysterectomy, but does not decrease the incidence of ureteral injury.

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Learning Curve of Laparoscopic Radical Hysterectomy With Pelvic and/or Para-Aortic Lymphadenectomy in the Early and Locally Advanced Cervical Cancer

Cited by 77 publications

References 23 publications

Minimally Invasive Surgery: A New Approach for Uterine Cervical Cancer

Minimally Invasive Surgery: A New Approach for Uterine Cervical Cancer

Robotic-Assisted Radical Hysterectomy Results in Better Surgical Outcomes Compared to the Traditional Laparoscopic Radical Hysterectomy for the Treatment of Cervical Cancer

Preset ureter catheter in laparoscopic radical hysterectomy of cervical cancer

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