Laparoscopic Lymphadenectomy and Radical or Modified Radical Vaginal Hysterectomy for Endometrial and Cervical Carcinoma: Preliminary Experience

With the standard vaginal surgical approaches to gynecologic malignancy, it is often difficult to remove the adnexa or to detect metastases in the abdominal cavity or the retroperitoneal lymph nodes. To address these difficulties, we studied a combined laparoscopic-vaginal surgical approach in patients with endometrial and early cervical carcinoma. A total of 15 patients were treated by this method, and 15 patients who had undergone standard exploratory laparotomy procedures were used as matched controls. Results indicate that with the laparoscopic-vaginal procedure there was a reduction in operative blood loss, number of patients transfused, number of blood transfusions, number of days with urinary catheter, and number of days in the hospital. Complications were about evenly distributed in the two groups. The laparoscopy procedures lasted 32 min longer, on average, than the laparotomies. Although a smaller number of lymph nodes were accounted for in the laparoscopy group, in these patients no visible nodal tissue remained in the dissected retroperitoneal area. We conclude that our results support continued use of this treatment modality. Further experience is needed to confirm the validity of our initial findings and to determine the impact of this method on long-term cure rates. (J GYNECOL SURG 11:147, 1995).