Page 24 - World Journal of Laparoscopic Surgery

Laparoscopic Radical Hysterectomy versus Open Radical Hysterectomy for Carcinoma Cervix Stage 1
REVIEW ARTICLE
Laparoscopic Radical Hysterectomy versus

Open Radical Hysterectomy for Carcinoma

Cervix Stage 1

SB Naval
Consultant, Obstetrician and Gynecologist, Naval Hospital and IVF Center, Jalgaon-425001, Maharashtra, India

Abstract
The present review has considered good number of studies involving fair large number of patients operated with both modalities for
carcinoma cervix stage 1. Minor differences in the operative techniques are ignored. Overall operation time for laparoscopic procedures
was required more. Incidence of intraoperative complication was also higher in addition to inherent complications related to
pneumoperitoneum. However, results in terms of disease free survival between the groups were comparable.
Advantages pertaining to reduced hospital stay and better cosmesis with laparoscopic modality at present do not outweigh the higher
incidence of intraoperative complication than that in open radical hysterectomy group.
Keywords: Radical hysterectomy, stage 1 cancer cervix, laparoscopy.

INTRODUCTION Results: Between November 1996 to December 2003,71 and 205
patients have undergone LARVH and RAH, respectively, for
In Indian population cervical cancer is in the first position
amongst cancers of reproductive organs. Even in the patients FIGO stage IA/IB carcinoma of the cervix. Both groups were
where detection of disease is not very late the easy and fully similar with respect to age and Quetelet index. All laparoscopic
satisfactory modality of treatment still is been searched. Advent procedures were completed successfully with no conversions
of modern technology has made available laparoscopic mode. to laparotomy. Intraoperative morbidity characteristics analyzed
It is worthwhile to find whether the laparoscopic radical (LARVH vs RAH) were blood loss 300 ml vs 500 ml (P < 0.001),
hysterectomy with pelvic and para-aortic lymadenectomy is a operative time 3.5 hours vs 2.5 hours (P < 0.001), and
better option. intraoperative complications 13% vs 4% (P < 0.03). Intraoperative
complications in the LARVH group included: cystotomy (7),
1
METHODOLOGY ureteric injury (1), and bowel injury. There was no difference in
transfusion rates. There was no difference between
Scope of review of published articles on this subject was made postoperative infectious and noninfectious complications
available through the search into Google, Highwire Press, Yahoo, (LARVH vs RAH), 9% vs 5% and 5% vs 2%, respectively. The
and Surgical Endoscopy journals.
median time to normal urine residual was 10 days vs 5 days (P <
0.001), and the median length of hospital stay was 1 day vs 5
REVIEW ARTICLES
days (P < 0.001). After a median follow-up of 17 and 21 months,
In a study at the university of Puerto Rico nineteen women there have been 4 recurrences in the LARVH group and 13 in
underwent laparoscopic radical hysterectomy or the RAH (P = NS). The overall 2 years recurrence-free survival
laparoscopically assisted vaginal radical hysterectomy, with was 94% and 94% in the LARVH and RAH groups, respectively
pelvic node dissection and para-aortic node dissection when (P = NS). The major benefits are less intraoperative blood loss
indicated. One procedure was converted to laparotomy due to and shorter hospital stay. It is a safe procedure with low overall
equipment failure, two minor postoperative complications. The morbidity and complication rates. However, at present, LARVH
second was incisional bleeding, which was controlled with is associated with an increase in intraoperative complications,
sutures applied using a local anesthetic, there have been no and patients may have an increased time to return to normal
incidents of recurrence. 1 bladder function. 2
Study of patients treated by laparoscopic-assisted radical
vaginal hysterectomy (LARVH) with time-matched radical STUDY DESIGN–1
abdominal hysterectomy (RAH) controls at our center. Records
2
of all patients with FIGO stage IA/IB cervical cancer undergoing Seventy-eight consecutive patients with stage IA and IB
radical surgery was studied. cervical cancer with at least 3 years of follow-up consented to

World Journal of Laparoscopic Surgery, September-December 2009;2(3):23-28 23