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Intrauterine Manipulator Use During Minimally Invasive Hysterectomy and Risk of Lymphovascular Space Invasion in Endometrial Cancer
  1. Hiroko Machida, MD*,,
  2. Marianne S. Hom, MD*,
  3. Crystal L. Adams, MD*,
  4. Sarah E. Eckhardt, MD*,
  5. Jocelyn Garcia-Sayre, MD*,
  6. Mikio Mikami, MD, PhD and
  7. Koji Matsuo, MD, PhD*,
  1. *Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA;
  2. Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan; and
  3. Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
  1. Address correspondence and reprint requests to Koji Matsuo, MD, PhD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, 2020 Zonal Ave, IRD 520, Los Angeles, CA 90033. E-mail:


Objective This study aimed to examine an association between intrauterine manipulator (IUM) use and frequency of lymphovascular space invasion (LVSI) in women with endometrial cancer undergoing minimally invasive hysterectomy.

Methods A retrospective case-control study was conducted among stage I–IV endometrial cancer patients who underwent hysterectomy between 2008 and 2015. Medical records were reviewed for patient demographics, surgical details, and tumor characteristics. Women who underwent total laparoscopic hysterectomy (TLH) with IUM use were compared with women who underwent total abdominal hysterectomy (TAH). Review of archived medical record for data collection and propensity score matching were performed to adjust for background differences between TLH-IUM and TAH groups. A systematic literature review with pooled analysis was performed to examine frequency of LVSI.

Results There were 687 women who underwent hysterectomy for endometrial cancer. Of those, 419 women underwent TLH with IUM use and 194 women underwent TAH. The most common type of IUM was VCare (89.5%). There was no statistically significant difference in the frequency of LVSI between the 2 groups: 15.1% for TLH-IUM vs 19.9% for TAH (P = 0.14). After propensity score matching, frequencies of LVSI were similar between the 2 groups: 21.2% for TLH-IUM vs 19.6% for TAH (P = 0.78). Systematic literature review identified 1371 cases of TLH-IUM and 1246 cases of TAH performed for endometrial cancer, and frequencies of LVSI were similar between the 2 groups (15.0% vs 13.6%, P = 0.31).

Conclusion Our study suggests that IUM use during TLH for endometrial cancer is not associated with increased frequency of LVSI.

  • Endometrial cancer
  • Uterine manipulator
  • Minimally invasive surgery
  • Hysterectomy
  • LVSI
  • Lymphovascular space invasion

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  • Funding support: This study was supported by the Ensign Endowment for Gynecologic Cancer Research (K.M.).

  • The authors declare no conflict of interest in this study.

  • The abstract of the study was presented at 18th APAGE Annual Congress 2017 (Okayama, Japan; September 6–9, 2017) and 2017 Western Association of Gynecologic Oncology (Rancho Mirage, CA; June 14–17, 2017).