Laparoscopic radical hysterectomy with lymphadenectomy in patients with early cervical cancer: our instruments and technique.

The purpose of this study is to describe the technique of total laparoscopic radical hysterectomy (type III procedure) with lymphadenectomy as performed at the Advanced Gynecological Endoscopy Center of the Malzoni Medical Center, Avellino, Italy. Seventy-seven patients underwent total laparoscopic radical hysterectomy (type II, III) with lymphadenectomy between January 2000 and March 2008. FIGO stage included five patients Ia1 with LVSI (lymph-vascular involvement), 24 patients Ia2, and 48 patients Ib1. 60 patients underwent a class III procedure and 17 patients a class II procedure according to the Piver classification. Histological types included squamous cell carcinoma in 65 patients, adenocarcinomas in 10 patients, and adenosquamous carcinoma in two. Para-aortic lymphadenectomy was performed up to the level of the inferior mesenteric artery in eight cases with positive pelvic lymph nodes at frozen section evaluation. Total laparoscopic radical hysterectomy can be considered a safe and effective therapeutic procedure for the management of early stage cervical cancer with a low morbidity; moreover, the laparoscopic route may offer an alternative option for patients undergoing radical hysterectomy, although multicenter studies and long-term follow-up are required to evaluate the oncologic outcomes of this procedure.