STUDY OBJECTIVE: To compare the perioperative outcome of laparoendoscopic single-site (LESS-RH) and minilaparoscopic radical hysterectomy (mLPS-RH). DESIGN: Retrospective multicenter study (Canadian Task Force Classification II-2). SETTING: Early stage cervical cancer. PATIENTS: Forty-six patents with FIGO stage IA2-IB1/IIA1 cervical cancer were included. Nineteen patients (41.3%) received LESS-RH, and 27 cases (58.7%) mLPS-RH. Pelvic lymph node dissection (PLND) was performed in all patients of cases. INTERVENTIONS: In the LESS-RH group all surgical procedures were performed through single umbilical multichannel port. In the mLPS group, RH was completed using a 5-mm umbilical optical trocar, and three additional 3-mm ancillary trocars placed suprapubically, and in the left/right lower abdominal regions. MEASUREMENTS AND MAIN RESULTS: There was no difference in clinic-pathological characteristics at the time of diagnosis between the LESS-RH and mLPS-RH groups. Median operative time was 270 (149-380) minutes in LESS-RH and 180 (90-240) minutes in the mLPS-RH group (p value=0.001). No further differences were detected in terms of type of RH, number of lymph nodes removed, or perioperative outcomes between the two groups. Conversion to laparotomy occurred in one patient (5.3%) in the LESS-RH group, following external iliac vein injury. Furthermore, in another woman treated with LESS approach, conversion to standard laparoscopy was required due to truncal obesity. In the mLPS-RH group, no conversions were observed, but reoperation for repair of a ureteral injury occurred. The percentage of patients discharged one day after surgery was significantly higher in the LESS-RH (57.9%), compared to mLPS-RHgroup (25.0%; p value=0.030). After a median follow-up of 27 months (9-73) only one patient, treated with mLPS-RH, experienced pelvic recurrence and died of disease. CONCLUSIONS: Both LESS-RH and mLPS-RH are feasible ultra minimally invasive approaches for completion of RH plus PLND. Further technical improvements are required to allow a wider diffusion of these techniques for more complex procedures.

Scambia, G., Fagotti, A., Ghezzi, F., Boruta, D., Escobar, P., Fader, A., Malzoni, M., Fanfani, F., Minilaparoscopic radical hysterectomy (mLPS-RH) vs. laparoendoscopic single-site radical hysterectomy (LESS-RH) in early stage cervical cancer: a multicenter retrospective study., <<JOURNAL OF MINIMALLY INVASIVE GYNECOLOGY>>, 2014; 21 (6): 1005-1009. [doi:10.1016/j.jmig.2014.04.008] [http://hdl.handle.net/10807/60961]

Minilaparoscopic radical hysterectomy (mLPS-RH) vs. laparoendoscopic single-site radical hysterectomy (LESS-RH) in early stage cervical cancer: a multicenter retrospective study.

Scambia, Giovanni;Fagotti, Anna;Fanfani, Francesco
2014

Abstract

STUDY OBJECTIVE: To compare the perioperative outcome of laparoendoscopic single-site (LESS-RH) and minilaparoscopic radical hysterectomy (mLPS-RH). DESIGN: Retrospective multicenter study (Canadian Task Force Classification II-2). SETTING: Early stage cervical cancer. PATIENTS: Forty-six patents with FIGO stage IA2-IB1/IIA1 cervical cancer were included. Nineteen patients (41.3%) received LESS-RH, and 27 cases (58.7%) mLPS-RH. Pelvic lymph node dissection (PLND) was performed in all patients of cases. INTERVENTIONS: In the LESS-RH group all surgical procedures were performed through single umbilical multichannel port. In the mLPS group, RH was completed using a 5-mm umbilical optical trocar, and three additional 3-mm ancillary trocars placed suprapubically, and in the left/right lower abdominal regions. MEASUREMENTS AND MAIN RESULTS: There was no difference in clinic-pathological characteristics at the time of diagnosis between the LESS-RH and mLPS-RH groups. Median operative time was 270 (149-380) minutes in LESS-RH and 180 (90-240) minutes in the mLPS-RH group (p value=0.001). No further differences were detected in terms of type of RH, number of lymph nodes removed, or perioperative outcomes between the two groups. Conversion to laparotomy occurred in one patient (5.3%) in the LESS-RH group, following external iliac vein injury. Furthermore, in another woman treated with LESS approach, conversion to standard laparoscopy was required due to truncal obesity. In the mLPS-RH group, no conversions were observed, but reoperation for repair of a ureteral injury occurred. The percentage of patients discharged one day after surgery was significantly higher in the LESS-RH (57.9%), compared to mLPS-RHgroup (25.0%; p value=0.030). After a median follow-up of 27 months (9-73) only one patient, treated with mLPS-RH, experienced pelvic recurrence and died of disease. CONCLUSIONS: Both LESS-RH and mLPS-RH are feasible ultra minimally invasive approaches for completion of RH plus PLND. Further technical improvements are required to allow a wider diffusion of these techniques for more complex procedures.
2014
Inglese
Scambia, G., Fagotti, A., Ghezzi, F., Boruta, D., Escobar, P., Fader, A., Malzoni, M., Fanfani, F., Minilaparoscopic radical hysterectomy (mLPS-RH) vs. laparoendoscopic single-site radical hysterectomy (LESS-RH) in early stage cervical cancer: a multicenter retrospective study., <<JOURNAL OF MINIMALLY INVASIVE GYNECOLOGY>>, 2014; 21 (6): 1005-1009. [doi:10.1016/j.jmig.2014.04.008] [http://hdl.handle.net/10807/60961]
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