title: Timing of Intrauterine Manipulator Insertion During Minimally Invasive Surgical Staging and Results of Pelvic Cytology in Endometrial Cancer.
abstract: OBJECTIVE
  Considering the hypothetical concern of retrograde tumor spread to the peritoneal cavity by insertion of an intrauterine manipulator, we examined the correlation between the timing of manipulator insertion and the results of pelvic cytology during total laparoscopic hysterectomy (TLH) in endometrial cancer.
  
  
  METHODS
  Case-control study (Canadian Task Force classification II-2).
  
  
  METHODS
  University-based hospitals.
  
  
  METHODS
  Stage I to IV endometrial cancer patients who underwent TLH in which an intrauterine manipulator was used. Medical records were reviewed for patient demographics, surgical details, and tumor characteristics.
  
  
  METHODS
  Archived medical record review.
  
  
  RESULTS
  A total of 333 patients was identified. Cases were divided into those with intrauterine manipulator insertion after pelvic cytology sampling (Group 1, n = 103) and those with intrauterine manipulator insertion before pelvic cytology sampling (Group 2, n = 230). Types of intrauterine manipulator were similar across the 2 groups (p = .77). There was no statistical difference in the results of pelvic cytology between the 2 groups: Group 1 versus 2, atypical cells 2.9% versus 4.8% and malignant cells 5.8% versus 9.6% (p = .36). Uterine perforation related to intrauterine manipulator insertion was seen in 1.0% and .4% of each group (p = .52). In a multivariate analysis controlling for demographics and tumor characteristics, advanced-stage disease remained an independent risk factor associated with increased risk of atypical and malignant cells (adjusted odds ratio, 10.3; 95% confidence interval, 4.44-23.8; p < .001).
  
  
  CONCLUSIONS
  Our study suggested that the timing of intrauterine manipulator insertion during TLH for endometrial cancer is not associated with the results of pelvic cytology.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Machida
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California.
authors.forename: Jacob P
authors.initials: JP
authors.lastname: Casey
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Garcia-Sayre
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California.
authors.forename: Carrie E
authors.initials: CE
authors.lastname: Jung
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Casabar
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California.
authors.forename: Aida
authors.initials: A
authors.lastname: Moeini
authors.affiliation: Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan.
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Kato
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California; Norris Comprehensive Cancer Center, Los Angeles, California.
authors.forename: Lynda D
authors.initials: LD
authors.lastname: Roman
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California; Norris Comprehensive Cancer Center, Los Angeles, California. Electronic address: koji.matsuo@med.usc.edu.
authors.forename: Koji
authors.initials: K
authors.lastname: Matsuo
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003581:Cytodiagnosis; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010388:Pelvis / Q000601:surgery; D010529:Peritoneal Cavity / Q000166:cytology* / Q000601:surgery; D012307:Risk Factors
keywords: Cytology; Endometrial cancer; Minimal invasive surgery; Uterine manipulator