Does a uterine manipulator affect cervical cancer pathology or identification of lymphovascular space involvement?
OBJECTIVE
Uterine manipulators are a useful adjunct for robotic-assisted radical hysterectomy (RARH), but some surgeons avoid their use for fear of altering pathology or interpretation of lymphovascular space involvement (LVSI). We retrospectively compared clinico-pathological data and tumor pathology from patients with cervical cancer operated by laparotomy vs. RARH.


METHODS
Charts from cervical cancer patients who underwent radical hysterectomy from January-1997 to June-2010 were reviewed for tumor histology, grade, FIGO stage, lymph node status, LVSI, depth of invasion, and tumor size. A ConMed V-Care® uterine manipulator was used in all robotic cases. H&E stained slides from 20 robotic and 24 open stage IB1 cases with LVSI reported in the original pathology were re-reviewed by a blinded pathologist for analysis of tissue artifacts and LVSI.


RESULTS
Two-hundred-thirty-six cases (185 open, 51 robotic) with stages IA2, IB1 and IB2 cervical cancer were reviewed. No significant differences in histology (squamous cell carcinoma, 65% vs. 51%; p=0.1), IB1 lesion size (≤2 cm, 62% vs. 61%, p>0.1), LVSI (34% vs. 39%, p>0.1), and depth of stromal invasion (p>0.1) was found between open and robotic groups. Histologic examination of all IB1 cervical carcinomas revealed a higher degree of surface disruption [45% (9/20) vs. 12.6% (3/24), p=0.038] and artifactual "parametrial carryover" [65% (13/20) vs. 29% (7/24), p=0.037] in robotic vs. open groups, respectively, but no significant differences in the rate of LVSI.


CONCLUSIONS
RARH cases that utilized a uterine manipulator did not show any clinico-pathological differences in depth of invasion, LVSI, or parametrial involvement compared to open cases.
Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute, Orlando, FL 32804, USA. Joseph.A.Rakowski@dmu.edu
Joseph A
JA
Rakowski
Tien Anh N
TA
Tran
Sarfraz
S
Ahmad
Jeffrey A
JA
James
Lorna A
LA
Brudie
Peter J
PJ
Pernicone
Michael J
MJ
Radi
Robert W
RW
Holloway
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000295:instrumentation* / Q000379:methods; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009366:Neoplasm Seeding; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012371:Robotics / Q000295:instrumentation* / Q000379:methods; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery*