Introduction/Background During TLH (total laparoscopic hysterectomy), uterine perforation may occur while using uterine manipulator. Also, uterus is cut on manipulator without isolating cancer tissue from the pelvic cavity (‘open cut’). This later technique often used by surgeons even in specific oncological centers. We think, uterine perforation by vaginal manipulator and the vaginal ‘open cut’ technique may be associated with cancer tissue spillage in pelvic cavity followed by disease progression.
Methodology Case report.
Results We had 3 cases of disease fast progression after total laparoscopic hysterectomy using vaginal manipulator: 2 cases after uterine perforation in patients with end/ca and 1 case of fast residual disease after vaginal ‘open cut’ technique on manipulator in patient with cervical cancer. During all three, tumor macroscopic tissue spillage was evident.
After these cases, we avoid using vaginal manipulator in patients with end/ce cancer in order to avoid tumor spillage, associated with uterine perforation or technique of laparoscopic open colpotomy (‘open cut’). We use LAVH method and cut uterus by vaginal root, after isolating tumor tissue from entering pelvic cavity and disseminating.
We think, the advantages of LAVH in patients with end/cervical cancer:
Vaginal colpotomy (vs. intracorp. colpotomy) = No contact of tumor tissue to pelvic cavity!!
No risks of uterine perforation and disease spread in pelvic cavity.
Vaginal cuff access technically easy (especially in obese patients);
No additional time needed for vaginal manipulator installation; no need for 2nd assistant;
No technical difficulties associated with laparoscopic vaginal cuff cut, (obese patient, unexperienced 2nd assistant).
Conclusion In patients with endometrial/cervical cancer LAVH technique may prevent tumor spillage risks associated with vaginal manipulator use.
Disclosure Nothing to disclose.
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