Minilaparoscopic radical hysterectomy (mLPS-RH) vs laparoendoscopic single-site radical hysterectomy (LESS-RH) in early stage cervical cancer: a multicenter retrospective study

Abstract

Study objective: To compare the perioperative outcomes of laparoendoscopic single-site radical hysterectomy (LESS-RH) and minilaparoscopic radical hysterectomy (mLPS-RH).

Design: Retrospective study (Canadian Task Force classification II-2).

Setting: Seven institutions in Italy.

Patients: Forty-six patents with early cervical cancer (FIGO stage IA2-IB1/IIA1) were included in the study. Nineteen patients (41.3%) underwent LESS-RH, and 27 (58.7%) underwent mLPS-RH. Pelvic lymph node dissection was performed in all patients.

Interventions: In the LESS-RH group, all surgical procedures were performed through a single umbilical multichannel port. In the mLPS-RH group, the procedure was completed using a 5-mm umbilical optical trocar and 3 additional 3-mm ancillary trocars, placed suprapubically and in the left and right lower abdominal regions.

Measurements and main results: There was no difference in clinicopathologic characteristics at the time of diagnosis between the LESS-RH and mLPS-RH groups. Median operative time was 270 minutes (range, 149-380 minutes) for LESS-RH, and was 180 minutes (range, 90-240 minutes) for mLPS-RH (p = .001). No further differences were detected between the 2 groups insofar as type of radical hysterectomy, number of lymph nodes removed, or perioperative outcomes. In the LESS-RH group, conversion to laparotomy was necessary in 1 patient (5.3%) because of external iliac vein injury, and in another patient, conversion to standard laparoscopy was required because of truncal obesity. In the mLPS-RH group, no conversions were observed; however, a repeat operation was performed to repair a ureteral injury. The percentage of patients discharged 1 day after surgery was significantly higher in the LESS-RH group (57.9%) compared with the mLPS-RH group (25.0%) (p = .03). After a median follow-up of 27 months (range, 9-73 months), only 1 patient, who had undergone mLPS-RH, experienced pelvic recurrence and died of the disease.

Conclusions: Both LESS-RH and mLPS-RH are feasible ultra-minimally invasive approaches for performance of radical hysterectomy plus pelvic lymph node dissection. Further technical improvements are required to enable wider use of these techniques for more complex procedures.

Keywords: Early-stage cervical cancer; Laparoendoscopic single-site surgery; Minilaparoscopic surgery; Radical hysterectomy.