BACKGROUND: Laparoendoscopic single-site surgery (LESS) represents one of the latest innovations in minimally invasive surgery and has several potential applications in gynecologic oncology surgery. The purpose of this surgical video is to demonstrate the indication and technique for LESS radical hysterectomy for the treatment of early stage cervical cancer. CASE: A 48 year-old menopausal woman with a body mass index of 29 was diagnosed with a well differentiated, Stage IB1 cervical adenocarcinoma. She underwent a LESS radical hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy through a 2.0 centimeter (cm) umbilical incision. Estimated blood loss was 200 ml and total operative time was 251 min. No perioperative complications occurred and the patient was discharged the day after surgery. Final pathology revealed a residual 1.5 cm tumor with a depth of invasion of 5.8mm and no lymph vascular space invasion. The parametria, ovaries and 16 lymph nodes were negative for malignancy. All margins, including a vaginal margin 3.5 cm from the cervical tumor, were negative. Her umbilical incision healed well and was not visible at her 4 week post operative visit. She did not require adjuvant therapy and is without evidence of disease 6 months after surgery. CONCLUSIONS: The performance of LESS radical hysterectomy is feasible and safe in select women with apparent early-stage cervical cancer. In an effort to optimize operative and long-term oncologic outcomes, it is critical to continue exploring novel surgical approaches for the treatment of gynecologic cancers.
BACKGROUND: Laparoendoscopic single-site surgery (LESS) represents one of the latest innovations in minimally invasive surgery and has several potential applications in gynecologic oncology surgery. The purpose of this surgical video is to demonstrate the indication and technique for LESS radical hysterectomy for the treatment of early stage cervical cancer. CASE: A 48 year-old menopausal woman with a body mass index of 29 was diagnosed with a well differentiated, Stage IB1 cervical adenocarcinoma. She underwent a LESS radical hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy through a 2.0 centimeter (cm) umbilical incision. Estimated blood loss was 200 ml and total operative time was 251 min. No perioperative complications occurred and the patient was discharged the day after surgery. Final pathology revealed a residual 1.5 cm tumor with a depth of invasion of 5.8mm and no lymph vascular space invasion. The parametria, ovaries and 16 lymph nodes were negative for malignancy. All margins, including a vaginal margin 3.5 cm from the cervical tumor, were negative. Her umbilical incision healed well and was not visible at her 4 week post operative visit. She did not require adjuvant therapy and is without evidence of disease 6 months after surgery. CONCLUSIONS: The performance of LESS radical hysterectomy is feasible and safe in select women with apparent early-stage cervical cancer. In an effort to optimize operative and long-term oncologic outcomes, it is critical to continue exploring novel surgical approaches for the treatment of gynecologic cancers.
Authors: Kari L Ring; Pedro T Ramirez; Lesley B Conrad; William Burke; R Wendel Naumann; Mark F Munsell; Michael Frumovitz Journal: Int J Gynecol Cancer Date: 2015-07 Impact factor: 3.437