The First World Congress On: Controversies in Obstetrics, Gynecology & Infertility

June 30, 2011

Laparoscopic hysterectomy was first described in 1989 (Reich) and rapidly thereafter in 1991 laparoscopic pelvic lymphadenectomy was also described (Querleu). During the 1990s the role of pelvic and latterly para aortic lymphadenectomy has been extended and is now an integral part of best practice Gynaecological Oncology Departments.

 

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Laparoscopic hysterectomy was first described in 1989 (Reich) and rapidly thereafter in 1991 laparoscopic pelvic lymphadenectomy was also described (Querleu). During the 1990s the role of pelvic and latterly para aortic lymphadenectomy has been extended and is now an integral part of best practice Gynaecological Oncology Departments. Dargent has demonstrated the role of both extra peritoneal and trans peritoneal dissection of the pelvic and para aortic lymph nodes. All these authors have demonstrated the feasibility of the technique and the ability to achieve high node retrieval levels in their practice. The technique of pelvic lymphadenectomy will be briefly demonstrated using a video from the author’s department.

Comparisons of laparoscopic versus open laparotomy lymphadenectomy have not been formally made excepting using simple criteria such as nodal counts. We are now in a situation where the techniques have been used for a period of time which allows survival data to begin to accrue. 

In the author’s department over a 25 year period over one thousand open radical hysterectomies and node dissections have been performed and latterly some forty Coelio Schauta procedures with lymphadenectomy for cancer of the cervix. Plus laparoscopically assisted vaginal hysterectomy and lymphadenectomy for corpus cancer. The feasibility and applicability of these techniques have been well demonstrated. The author will discuss node retrieval, complications and early survival data for patients who have had laparoscopic lymphadenectomy performed for cancer of the body of the uterus and for cancer of the cervix.

It is now becoming clear that as the learning curve develops the commonly held belief that laparoscopic surgery is extraordinarily slow compared with open surgery is being refuted. In the author’s series the performance of a laparoscopic pelvic lymphadenectomy + Schauta procedure is now only very slightly longer than the open standard Wertheim Meigs hysterectomy. Node retrievals are equivalent, recovery from the procedure is very much faster for the laparoscopic patients and so far survival data appears to be equivalent.