Minimally invasive surgery is more work for the surgeon, but offers important benefits for the patient. Patients with early stage cervical cancer now have the option of laparoscopic hysterectomy. Dr. Sarah E. Taylor and colleagues at Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania published the results of a study comparing laparoscopy with traditional open surgery.
“Until the early 1990s, the standard surgical practice for early stage, nonbulky disease was radical abdominal hysterectomy with pelvic lymphadenectomy,” Taylor wrote. This procedure is associated with significant blood loss and recovery times. Laparoscopic surgery involves less cutting, with the potential for better results.
Tayor and colleagues performed a retrospective chart review of women who underwent the old and new procedures. Both were effective in treating cervical cancer. There were no cancer recurrences within the median follow-up time of about 35 months for patients with either type of surgery. The laparoscopic patients had fewer complications and spent less time in the hospital.
Taylor reported the following averages for the two types of surgery:
Operating time: 231.7 minutes for laparoscopic, 207.2 for open surgery
Blood loss: 161.1 mL for laparoscopic, 394.4 for open surgery
Operative complications: 0 for laparoscopic, 3 for open surgery
Blood transfusions: 0 for laparoscopic, 3 for open surgery
Wound infections: 0 for laparoscopic, 5 for open surgery
Length of stay in hospital: 2.9 days for laparoscopic, 5.5 for open surgery
Adjuvant therapy: 1 for laparoscopic, 4 for open surgery
Taylor's study was limited to a small number of patients: 9 for laparoscopic, 18 for open surgery. She explained that the laparascopic technique is still too new for the completion of large scale studies.
“Until we have data like this, it is important to continue to report on institutional experiences to add to the growing data on the feasibility and safety of the technique as an alternative to standard laparotomy,” Taylor wrote.
A similar study by Dr. Jin Woo Shin and colleagues in Korea compared total laparoscopic hysterectomy (TLH) with laparoscopy-assisted vaginal hysterectomy (LAVH).
They found that LAVH is preferred in patients with a relatively large uterus, and in those with a lower uterine segment mass. TLH requires more technical expertise. The authors concluded, “TLH and LAVH are safe and feasible methods.”
References:
1. Taylor SE et al, “Radical hysterectomy for early stage cervical cancer: Laparoscopy versus laparotomy”, JSLS 2011; 15(2): 213-17. http://www.ncbi.nlm.nih.gov/pubmed/21902978
2. Shin JW et al, “Total laparoscopic hysterectomy and laparoscopy-assisted vaginal vaginal hysterectomy”, JSLS 2011; 15(2): 218-21.
http://www.ncbi.nlm.nih.gov/pubmed/21902979
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.
Reviewed October 24, 2011
by Michele Blacksberg RN
Edited by Jody Smith