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

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.