Feasibility and safety of total laparoscopic radical hysterectomy

STUDY OBJECTIVE: To evaluate feasibility and morbidity of a total laparoscopic radical hysterectomy (TLRH). DESIGN: Retrospective chart review (Canadian Task Force classification II-3). SETTING: Gynecologic cancer center. PATIENTS: Fifty-five women with cervical (39), endometrial (8), vaginal (2), or recurrent colon cancer (1), or severe pelvic endometriosis (5) followed for 3 years. INTERVENTION: TLRH in 55 women, converted to laparotomy in 3 (5.5%). MEASUREMENTS AND MAIN RESULTS: Feasibility, safety, patterns of recurrence, and survival were assessed. Estimated blood loss was 200 ml (range 50-2000 ml), median total operating time was 210 minutes, and median hospital stay was 5 days. Intraoperative complications were three vascular injuries and one obturator nerve palsy, all of which occurred in the first half of the series. Early postoperative morbidity included deep vein thrombosis, pulmonary embolism, bladder infection and dysfunction, and vaginal fistula. These events occurred less frequently in the second half of the series. Late postoperative morbidity consisted of lymphedema, pelvic abscess and lymphocyst formation, pelvic cellulitis, hyperesthesia of the leg, and small bowel obstruction. The only fatality was a patient who developed a pulmonary embolus on postoperative day 3. Median follow-up was 36.5 months. Of 39 women with cervical cancer, 34 were alive and disease free at their last visit. No case of port site metastasis occurred during follow-up. CONCLUSION: TLRH carries acceptably low morbidity that can be reduced with experience with the technique.