Laparoscopic radical hysterectomy with pelvic lymphadenectomy for early, invasive cervical carcinoma.

STUDY OBJECTIVE: To demonstrate the feasibility and evaluate the efficacy of laparoscopic radical hysterectomy with pelvic lymphadenectomy for early, invasive cervical cancer.

DESIGN: Prospective study (Canadian Task Force classification II-2).

SETTING: University-affiliated hospital.

PATIENTS: Eighteen women (age range 29-70 yrs) with early, invasive cervical cancer.

INTERVENTION: Laparoscopic radical hysterectomy with pelvic lymphadenectomy.

MEASUREMENTS AND MAIN RESULTS: Diagnoses were squamous cell carcinoma in15 patients and adenocarcinoma of the cervix in 3; these were graded microcarcinoma in 6 and stage Ib (<4 cm) in 12. Mean operating time was approximately 363 +/- 65 minutes (range 240-475 min). Blood loss averaged 619 +/- 297 ml (range 250-1000 ml). The average number of pelvic lymph nodes obtained was 22.0 +/- 8.5 (range 14-40). Specimen weight averaged 117 +/- 67 g (range 60-340 g). Surgical margins were clear in all patients. No procedure was converted to laparotomy. There were no major intraoperative complications involving injury to main blood vessels, nerves, bowel, bladder, or ureters.

CONCLUSION: In our experience, laparoscopic radical hysterectomy with pelvic lymphadenectomy is acceptable in accordance with the standards of gynecologic oncology. Despite the longer operating time than traditional abdominal radical hysterectomy, all patients recovered as quickly as they would after laparoscopic-assisted vaginal hysterectomy. We believe that this procedure could be an alternative to abdominal radical hysterectomy for selected women, especially those who have stage Ib1 cervical cancer.