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Laparoscopic radical hysterectomy without uterine manipulator or vaginal tube use

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Abstract
In the Laparoscopic Approach to Cervical Cancer trial, minimally invasive surgery (MIS) has been associated with significantly lower disease-free survival and overall survival rates. The proposed reasons for the increased recurrence and mortality associated with MIS are uterine manipulation, the effect of insufflation gas (CO2), and intracorporeal colpotomy. We applied 2 techniques during surgery to reduce tumor spillage in laparoscopic radical hysterectomy (LRH), which included avoiding using a uterine manipulator and containing the colpotomy using an endoscopic stapler. We aimed to introduce an easy and comfortable traction method with tagged uterine sutures instead of a manipulator or vaginal tube for minimally invasive radical hysterectomy (RH). The patient underwent LRH. After entering the peritoneal cavity, tubal ligation was performed with an endoscopic clip to prevent tumor spillage via the fallopian tubes. Then, the uterine fundus was tied with needle-straightened multifilament Vicryl 2-0, and the tagged uterus was manipulated. Thereafter, pelvic lymphadenectomy was performed before RH. Thereafter, we performed intracorporeal colpotomy by resecting the vagina twice using an endoscopic stapler. Finally, the stapled vaginal stump was resected to retrieve the specimen via the vaginal opening using monopolar scissors after the vagina was washed several times with sterile water. After removing the specimen, the vaginal stump was endoscopically closed with a barbed suture. LRH can be feasibly performed in patients with uterine cervical neoplasm by retracting tagged uterine sutures without the use of a uterine manipulator.
All Author(s)
Eun Jung Yang ; A Jin Lee ; Kyeong A So ; Sun Joo Lee ; Tae Jin Kim ; Seung-Hyuk Shim
Issued Date
2023
Type
Article
Keyword
HysterectomyUterine cervical neoplasm
Publisher
대한부인종양학회
ISSN
2005-0380 ; 2005-0399
Citation Title
Journal of gynecologic oncology
Citation Volume
34
Citation Number
5
Citation Start Page
e63
Language(ISO)
eng
DOI
10.3802/jgo.2023.34.e63
URI
http://schca-ir.schmc.ac.kr/handle/2022.oak/1235
Appears in Collections:
산부인과 > 1. Journal Papers
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