Introduction/Background Peritoneal dissemination of cervical cancer cells during intracorporal colpotomy is discussed to be responsible for reduced disease free survival after laparoscopic radical hysterectomy as shown in the LACC study. However, data on the frequency or mechanisms of peritoneal contamination are missing. Therefore, we aimed to analyze peritoneal contamination of cervical secretion during intracorporal colpotomy with a novel indocyaningreen (ICG) -based technique.
Methodology In this prospective proof-of-principle study, we included patients undergoing routine laparoscopic or robot-assisted hysterectomy for benign indications. Routine surgery was performed after application of ICG specifically to the cervical surface (figure 1). During colpotomy pictures under white and fluorescence light were taken in order to evaluate frequency and extent of contamination.
Results Peritoneal contamination during intracorporal colpotomy occurred in 9/12 (75%) patients undergoing routine laparoscopic hysterectomy. Laparoscopic instruments were contaminated in 60% of all cases (figure 1C). Extent of contamination varied between individual patients with a median grade of 2.75 (range 1–4.5; 1 no contamination - 5 strong contamination) at posterior colpotomy. There were no adverse effects during surgery.
Conclusion Peritoneal contamination with cervical secretion is a frequent event during intracorporal colpotomy. We describe a promising novel tool for feasible and direct visualization of peritoneal contamination during colpotomy. This may be easily implemented in further studies on laparoscopic radical hysterectomy to assess the prognostic role of peritoneal contamination on survival and serve as a quality assessment tool for surgeons and surgical techniques.
Disclosure The author PH has authored a statement on the LACC study results by the Uterus Comission of the Study Group for Gynecologic Oncologs (AGO) and the and the Study Group for Gynecologic Endoscopy (AGE) of the German Society for Gynecology and Obstetrics (DGGG). All other authors report no conflict of interest.
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