Laparoscopic assisted parametrectomy/upper vaginectomy (LPUV)-technique, applications and results.

Objective: In this analysis, we summarize our experiences with the laparoscopic parametrectomy/upper vaginectomy (LPUV) as a treatment option for patients with an unexpected finding of cervical cancer after simple hysterectomy as well as for patients with cancer of the vaginal cuff.
Methods: From 1995-2004, 6 of our patients underwent LPUV including 5 patients with stage Ib(1) cervical cancer and one patient with Ia(1) cervical cancer. Prior procedures were TVH (n = 3), TAH (n = 2) or LAVH (n = 1). Charts were reviewed and follow-up data were collected.
Results: Mean age was 40.5 (38-49) years and Quetelet index was 31.5 (25-40) kg/m(2). Average time from hysterectomy to LPUV was 54 (30-84) days. Retrospective FIGO staging revealed stage Ib(1) (n = 5) and stage Ia(1) (n = 1) cervical cancer. Mean duration of surgery was 207 (151-265) min, average blood loss 300 (100-500) mL. One patient had an intraoperative bladder injury and one patient a bowel injury. Histopathological evaluation found residual adenocarcinoma in situ in one patient and no malignancy in all other specimen. All pelvic (average 22 (10-36) nodes, n = 6) and paraaortic nodes (9 nodes, n = 1) were negative for malignancy. One patient had postoperative hematocrit drop and required blood transfusion, mean hematocrit difference pre- vs. postoperative was 6.4 (0.2-10.9) %. There were no further postoperative complications during the average hospital stay of 3.5 (2-5) days. No patient required adjuvant therapy after the operation. There were no recurrences or late complications in an average of 21.5 (3-50) months of follow-up.
Conclusion: LPUV is an alternative to open parametrectomy or radiation therapy in patients with unexpected cervical cancer after simple hysterectomy or cancer of the vaginal stump. Bladder injuries must be considered to be a specific complication of this otherwise safe procedure.