Laparoscopic Radical Hysterectomy: A Preliminary Experience

From June 1993 through September 1993, we had performed four cases of laparoscopic radical hysterectomy. All these patients had early cervical squamous cell carcinoma of less than 4 cm in diameter. We first developed the left paravesical and pararectal space with the suction-irrigator probe and Endoretractor (Autosure, USA). Then we desiccated the left uterine artery at its origin. The left ureter was dissected from the point it enters the pelvis to the ureteric canal. The left cardinal ligament was completely divided twice by the EndoGIA (Autosuture, USA). The rectovaginal space was opened and the uterosacral ligament was transected by electrosurgery. The left ureter was dissected and unroofed to the point it enters the bladder with Endodissector and electrosurgery. The left paracolpos was divided by EndoGIA. The same procedures were repeated on the right side. The anterior and posterior colpotomy could be done by monopolar electrosurgery but they were deferred until the lymph node dissection was completed. Finally, we did pelvic lymph node dissection and colpotomy, after which we removed the uterus through the vagina. We closed the vaginal cuff from below. The operation time ranged from 5.5 to 8 hours. The blood loss ranged from 150 to 500 ml. The lymph nodes dissected ranged from seven to nine in number. The parametrium removed was 3.5 x 2.5 x 2 cm on average. The vaginal cuff removed was at least 2 cm in length. The patients recovered quickly and the hospital stay was shorter than that needed for those patients undergoing traditional abdominal radical hysterectomy. In conclusion, we think the preliminary results were satisfactory. More experience is needed to answer the question of whether laparoscopic radical hysterectomy can be an alternative to traditional abdominal radical hysterectomy in some selected cases.