Laparoscopic radical hysterectomy with lymphadenectomy in cervical cancer: our technique and experience

Objective: To describe our technique of total laparoscopic radical hysterectomy (LRH) in cervical cancer and share our experience. Materials and Methods: Retrospective study of 53 non-consecutive patients with International Federation of Gynaecology and Obstetrics (FIGO) Stage IA2 (n=1), IB1 (n=26), and IB2 (n=26) cervical cancer. All patients underwent total LRH with bilateral pelvic lymphadenectomy. Harmonic shears were the primary instrument used for the dissection, transection, and maintenance of hemostasis. Hemostasis was also achieved using bipolar graspers if deemed necessary. This study was approved by the local institutional review board (Sangini Hospital Ethics Committee), IRB registration number IRB00008709. Results: The median age was 47 (range, 28-70) years, with a median body mass index of 25.7 (range, 16- 32) kg/m2 . The median operative time was 103 (range, 61-150) minutes. There were no intraoperative complications. Median blood loss was 30 (range 20-135) mL. None of the cases required conversion to laparotomy. Postoperative complication rate was seen in 18 (34%) patients. Urinary dysfunction was the most common postoperative complication seen in 13 (24.5%) patients. The median number of pelvic nodes resected was 20 (range, 8-55). The surgical margins were free of disease in all cases. The median length of stay was four (range, 2-8) days. Thirty-five patients required adjuvant therapy post surgery. The median follow-up in this study was 38 (range 0-97) months. Recurrence of the disease was seen in three patients. Four patients expired. The estimated three-year overall survival rate was 92.6% in patients with disease ≤ IB1 and 92.3% in those > IB1. Conclusion: The present technique of LRH is safe, feasible, and associated with less morbidity. It is associated with minimal intraoperative complications, blood loss, shorter operative time, and outcomes comparable to other studies. The present technique consists of simple steps, which are easily reproducible and replicable once the learning curve has been surpassed.

Laparoscopic radical hysterectomy; Cervical cancer; Pelvic lymphadenectomy.

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