Vaginal-assisted laparoscopic radical hysterectomy: rationale, technique, results.
OBJECTIVE
Total laparoscopic radical hysterectomy (TLRH) makes it difficult to resect adequate vaginal cuff according to tumor size and to avoid tumor spread after opening the vagina. Laparoscopic-assisted radical vaginal hysterectomy (LARVH) is associated with higher risk for urologic complications.


METHODS
The vaginal-assisted laparoscopic radical hysterectomy (VALRH) technique comprises 3 steps: (1) comprehensive laparoscopic staging, (2) creation of a tumoradapted vaginal cuff, and (3) laparoscopic transsection of parametria. We retrospectively analyzed data of 122 patients who underwent VALRH for early stage cervical cancer (n=110) or stage II endometrial cancer (n=12) between January 2007 and December 2009 at Charité University Berlin.


RESULTS
All patients underwent VALRH without conversion. Mean operating time was 300 minutes, and mean blood loss was 123cc. On average, 36 lymph nodes were harvested. Intra- and postoperative complication rates were 0% and 13.1%, respectively. Resection was in sound margins in all patients. After median follow-up of 19 months, disease-free survival and overall survival for all 110 cervical cancer patients was 94% and 98%, and for the subgroup of patients (n=90) with tumors ≤pT1b1 N0 V0 L0/1 R0, 97% and 98%, respectively.


CONCLUSIONS
VALRH is a valid alternative to abdominal radical hysterectomy and LARVH in patients with earlystage cervical cancer and endometrial cancer stage II with minimal intraoperative complications and identical oncologic outcomes.
Department of Gynecology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Elisabeth
E
Gottschalk
Malgorzata
M
Lanowska
Vito
V
Chiantera
Simone
S
Marnitz
Achim
A
Schneider
Verena
V
Brink-Spalink
Kati
K
Hasenbein
Christhardt
C
Koehler
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011183:Postoperative Complications; D016019:Survival Analysis; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*