title: Laparoendoscopic single-site radical hysterectomy with pelvic lymphadenectomy: initial multi-institutional experience for treatment of invasive cervical cancer.
abstract: OBJECTIVE
  To describe the feasibility, safety, and outcomes of women with stage I cervical cancer treated with laparoendoscopic single-site surgery radical hysterectomy (LESS-RH).
  
  
  METHODS
  A retrospective descriptive study (Canadian Task Force classification III).
  
  
  METHODS
  Multiple academic teaching hospitals.
  
  
  METHODS
  Women with Fédération Internationale de Gynécologie et d'Obstétrique FIGO stage IA1 to IB1 cervical cancer.
  
  
  METHODS
  LESS-RH as the primary therapy for cervical cancer performed by a gynecologic oncologist with expertise in LESS. A multichannel, single-port access device; a flexible-tipped 5-mm laparoscope; and a multifunctional instrument were used in all cases. Clinicopathologic, surgical, and perioperative outcomes were analyzed.
  
  
  RESULTS
  Twenty-two women were identified in whom a LESS-RH was attempted; 20 (91%) successfully underwent the procedure, including 19 in whom pelvic lymphadenectomy (PLND) was completed. Of the 2 converted procedures, 1 patient underwent 2-port laparoscopy secondary to truncal obesity, and 1 patient underwent conversion to laparotomy secondary to external iliac vein laceration during PLND. The median age and body mass index were 46 years and 23.3 kg/m(2), respectively. The median number of pelvic lymph nodes removed was 22. One patient experienced an intraoperative complication, and no patient required reoperation. The margins of excision were negative. One patient with 2 positive pelvic nodes and 1 patient with microscopic parametrial disease received adjuvant chemosensitized radiation; 3 additional patients received adjuvant radiation therapy secondary to an intermediate risk for recurrence. After a median follow up of 11 months, no recurrences were detected.
  
  
  CONCLUSIONS
  LESS-RH/PLND is feasible and safe for select patients with stage I cervical cancer. Larger studies are needed to confirm whether the increased technical difficulty of this procedure justifies its use in routine gynecologic oncology practice.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: dboruta@partners.org.
authors.forename: David M
authors.initials: DM
authors.lastname: Boruta
authors.affiliation: Division of Minimally Invasive Gynecology, University of Perugia, St. Maria Hospital, Terni, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Fagotti
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Leslie S
authors.initials: LS
authors.lastname: Bradford
authors.affiliation: Division of Gynecologic Oncology, HIMA-San Pablo, Caguas, Puerto Rico; Division of Gynecologic Oncology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Pedro F
authors.initials: PF
authors.lastname: Escobar
authors.affiliation: Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
authors.affiliation: Division of Gynecologic Oncology, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Christina L
authors.initials: CL
authors.lastname: Kushnir
authors.affiliation: Division of Gynecologic Oncology, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Chad M
authors.initials: CM
authors.lastname: Michener
authors.affiliation: Division of Gynecologic Oncology, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Amanda Nickles
authors.initials: AN
authors.lastname: Fader
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods / Q000706:statistics & numerical data*; D010535:Laparoscopy / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D010388:Pelvis / Q000601:surgery; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000601:surgery*
keywords: Cervical cancer; Laparoendoscopic single-site surgery; Radical hysterectomy