@article {JaparidzeA228, author = {M Japaridze}, title = {EP318 Laparoscopically assisted vaginal hysterectomy: best surgical approach in patients with endometrial/cervical cancer?}, volume = {29}, number = {Suppl 4}, pages = {A228--A229}, year = {2019}, doi = {10.1136/ijgc-2019-ESGO.379}, publisher = {BMJ Specialist Journals}, abstract = {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 ({\textquoteleft}open cut{\textquoteright}). This later technique often used by surgeons even in specific oncological centers. We think, uterine perforation by vaginal manipulator and the vaginal {\textquoteleft}open cut{\textquoteright} 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 {\textquoteleft}open cut{\textquoteright} 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 ({\textquoteleft}open cut{\textquoteright}). 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.}, issn = {1048-891X}, URL = {https://ijgc.bmj.com/content/29/Suppl_4/A228.2}, eprint = {https://ijgc.bmj.com/content/29/Suppl_4/A228.2.full.pdf}, journal = {International Journal of Gynecologic Cancer} }