Skip to main content
SpringerLink
Log in

Complications of laparoscopic radical hysterectomy and lymphadenectomy for invasive cervical cancer: experience based on 317 procedures

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

This report presents the incidence of complications and conversions during laparoscopic radical hysterectomy and lymphadenectomy performed for invasive cervical carcinoma. The data are analyzed, and strategies to help prevent future complications are discussed.

Methods

From July 2000 to December 2005 at the authors’ institution, 317 laparoscopic radical hysterectomy and lymphadenectomy procedures for invasive cervical carcinoma were performed. The authors reviewed the database of patients who underwent laparoscopic radical hysterectomy and lymphadenectomy to examine complications and analyze factors associated with conversion to an open surgical procedure.

Results

All but four surgical procedures were laparoscopically completed. Pelvic lymphadenectomy was performed for all the remaining 313 patients, 143 of whom underwent paraaortic lymphadenectomy. Major and minor intraoperative complications occurred for 4.4% (n = 14) of the patients. The overall conversion rate was 1.3% (n = 4), including 3 emergencies and 1 elective conversion. Seven patients had vessel injuries, five of which were repaired or treated laparoscopically. One left external iliac vein required laparotomy, and one patient underwent laparotomy to control bleeding sites. Operative cystotomies occurred in five patients, which were repaired laparoscopically. Two patients underwent laparotomy because of hypercapnia and ascending colon injury. Postoperative surgery complications occurred in 5.1% (n = 16) of the patients, including 5 patients with ureterovaginal fistula, 4 with vesicovaginal fistula requiring reoperation, 1 with ureterostenosis treated by placement of a double-J ureteral stent, and 6 with bladder dysfunctions (retention) that exhibited complete resolution within 3 to 6 months by intermittent training and catheterization.

Conclusions

Laparoscopic radical hysterectomy and lymphadenectomy is becoming a routine procedure in the armamentarium of many gynecologists. Complications unique to laparoscopy do exist, but they decrease with repeated training of the procedure and gradually enriched experiences.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.

Similar content being viewed by others

References

  1. Childers JM, Hatch KD, Tran AN, Surwit EA (1993) Laparoscopic paraaortic lymphadenectomy in gynecologic malignancies. Obstet Gynecol 82: 741–747

    PubMed  CAS  Google Scholar 

  2. Childers JM, Spirtos NM, Brainard P, Surwit EA (1994) Laparoscopic staging of the patient with incompletely staged early adenocarcinoma of the endometrium. Obstet Gynecol 83: 597–600

    Article  PubMed  CAS  Google Scholar 

  3. Dargent DF (2001) Laparoscopic surgery in gynecologic oncology. Surg Clin North Am 81: 949–964

    Article  PubMed  CAS  Google Scholar 

  4. Dargent D, Enria R (2003) Laparoscopic assessment of the sentinel lymph nodes in early cervical cancer: technique—preliminary results and future developments. Crit Rev Oncol Hematol 48: 305–310

    Article  PubMed  Google Scholar 

  5. Eltabbakh GH (2000) Effect of surgeon’s experience on the surgical outcome of laparoscopic surgery for women with endometrial cancer. Gynecol Oncol 78: 58–61

    Article  PubMed  CAS  Google Scholar 

  6. Eltabbakh GH, Shamonki MI, Moody JM, Garafano LL (2001) Laparoscopy as the primary modality for the treatment of women with endometrial carcinoma. Cancer 91: 378–387

    Article  PubMed  CAS  Google Scholar 

  7. Hertel H, Kohler C, Michels W, Possover M, Tozzi R, Schneider A (2003) Laparoscopic-assisted radical vaginal hysterectomy (LARVH): prospective evaluation of 200 patients with cervical cancer. Gynecol Oncol 90: 505–511

    Article  PubMed  Google Scholar 

  8. Holub Z, Bartos P, Dorr A, Eim J, Jabor A, Kliment L Jr (1999) The role of laparoscopic hysterectomy and lymph node dissection in treatment of endometrial cancer. Eur J Gynaecol Oncol 20: 268–271

    PubMed  CAS  Google Scholar 

  9. Holub Z, Jabor A, Bartos P, Eim J, Urbanek S, Pivovarnikova R (2002) Laparoscopic surgery for endometrial cancer: long-term results of a multicentric study. Eur J Gynaecol Oncol 23: 305–310

    PubMed  CAS  Google Scholar 

  10. Holub Z, Jabor A, Bartos P, Hendl J, Urbanek S (2003) Laparoscopic surgery in women with endometrial cancer: the learning curve. Eur J Obstet Gynecol Reprod Biol 107: 195–200

    Article  PubMed  Google Scholar 

  11. Kamprath S., Janitzky V., Noschel H., Schneider A. (1996) Laparoscopic management of a ureteral lesions in Schauta-Stoeckel radical vaginal hysterectomy. Zentralbl Gynakol 118: 414–416

    PubMed  CAS  Google Scholar 

  12. Klemm P, Frober R, Kohler C, Schneider A (2005) Vascular anomalies in the paraaortic region diagnosed by laparoscopy in patients with gynaecologic malignancies. Gynecol Oncol 96: 278–282

    Article  PubMed  Google Scholar 

  13. Köhler C, Klemm P, Schau A, Possover M, Krause N, Tozzi R, Schneider A. (2004) Introduction of transperitoneal lymphadenectomy in a gynecologic oncology center: analysis of 650 laparoscopic pelvic and/or paraaortic transperitoneal lymphadenectomies. Gynecol Oncol 95: 52–61

    Article  PubMed  Google Scholar 

  14. Lang GS, Ruckle HC, Hadley HR, Lui PD, Stewart SC (1994) One hundred consecutive laparoscopic pelvic lymph node dissections: comparing complications of the first 50 cases to the second 50 cases. Urology 44: 221–225

    Article  PubMed  CAS  Google Scholar 

  15. Liang Z, Xu H, Xiong G, Li Y, Chen Y, Wang L, He W, Shi C (2002) Clinical analysis of laparoscopic pelvic and paraaortic lymphadenectomy treated patients with gynecological malignancies. Zhonghua Fu Chan Ke Za Zhi 37: 656–659

    PubMed  Google Scholar 

  16. Liang ZQ, Xu HC, Xiong GW, Li YY, Chen Y, Wang L, Chang Q, Shi CX (2003) Clinical evaluation of laparoscopic radical hysterectomy with pelvic and paraaortic lymphadenectomy in patients with cervical cancer. Zhonghua Fu Chan Ke Za Zhi 38: 409–411

    PubMed  Google Scholar 

  17. Malur S, Possover M, Schneider A (2001) Laparoscopically assisted radical vaginal versus radical abdominal hysterectomy type II in patients with cervical cancer. Surg Endosc 15: 289–292

    Article  PubMed  CAS  Google Scholar 

  18. Massi G, Savino L, Susini T. (1996) Three classes of radical vaginal hysterectomy for treatment of endometrial and cervical cancer. Am J Obstet Gynecol 175: 1576–1585

    Article  PubMed  CAS  Google Scholar 

  19. Milad MP, Morrison K, Sokol A, Miller D, Kirkpatrick L (2001) A comparison of laparoscopic supracervical hysterectomy vs laparoscopically assisted vaginal hysterectomy. Surg Endosc 15: 286–288

    Article  PubMed  CAS  Google Scholar 

  20. Nezhat CR, Burrell MO, Nezhat FR, Benigno BB, Welander CE (1992) Laparoscopic radical hysterectomy with paraaortic and pelvic node dissection. Am J Obstet Gynecol 166: 864–865

    PubMed  CAS  Google Scholar 

  21. Nezhat CR, Nezhat FR, Burrell MO, Ramirez CE, Welander C, Carrodeguas J, Nezhat CH (1993) Laparoscopic radical hysterectomy and laparoscopically assisted vaginal radical hysterectomy with pelvic and paraaortic node dissection. J Gynecol Surg 9: 105–120

    Article  PubMed  CAS  Google Scholar 

  22. Piver MS, Rutledge F, Smith JP (1974) Five classes of extended hysterectomy for women with cervical cancer. Obstet Gynecol 44: 265–272

    PubMed  CAS  Google Scholar 

  23. Possover M, Krause N, Kuhne-Heid R, Schneider A (1998) Laparoscopic assistance for extended radicality of radical vaginal hysterectomy: description of a technique. Gynecol Oncol 70: 94–99

    Article  PubMed  CAS  Google Scholar 

  24. Possover M, Krause N, Plaul K, Kuhne-Heid R, Schneider A (1998) Laparoscopic paraaortic and pelvic lymphadenectomy: experience with 150 patients and review of the literature. Gynecol Oncol 71: 19–28

    Article  PubMed  CAS  Google Scholar 

  25. Querleu D (1993) Laparoscopically assisted radical vaginal hysterectomy. Gynecol Oncol 51: 248–254

    Article  PubMed  CAS  Google Scholar 

  26. Querleu D, LeBlanc E (1994) Laparoscopic infrarenal paraaortic lymph node dissection for restaging of carcinoma of the ovary or fallopian tube. Cancer 73: 1467–1471

    Article  PubMed  CAS  Google Scholar 

  27. Schneider A, Possover M, Kamprath S, Endisch U, Krause N, Noschel H (1996) Laparoscopy-assisted radical vaginal hysterectomy modified according to Schauta-Stoeckel. Obstet Gynecol 88: 1057–1060

    Article  PubMed  CAS  Google Scholar 

  28. Scribner DR Jr, Walker JL, Johnson GA, McMeekin SD, Gold MA, Mannel RS (2001) Surgical management of early-stage endometrial cancer in the elderly: is laparoscopy feasible? Gynecol Oncol 83: 563–568

    Article  PubMed  Google Scholar 

  29. Sedlacek TV, Campion MJ, Hutchins RA, Reich H (1994) Laparoscopic radical hysterectomy: a preliminary report. J Am Assoc Gynecol Laparosc 1: S32

    Article  PubMed  Google Scholar 

  30. Spirtos NM, Schlaerth JB, Kimball RE, Leiphart VM, Ballon SC (1996) Laparoscopic radical hysterectomy (type III) with aortic and pelvic lymphadenectomy. Am J Obstet Gynecol 174: 1763–1767; discussion 1767–1768

    Article  PubMed  CAS  Google Scholar 

  31. Spirtos NM, Eisenkop SM, Schlaerth JB, Ballon SC (2002) Laparoscopic radical hysterectomy (type III) with aortic and pelvic lymphadenectomy in patients with stage I cervical cancer: surgical morbidity and intermediate follow-up. Am J Obstet Gynecol 187: 340–348

    Article  PubMed  Google Scholar 

  32. Steed H, Rosen B, Murphy J, Laframboise S, De Petrillo D, Covens A (2004) A comparison of laparascopic-assisted radical vaginal hysterectomy and radical abdominal hysterectomy in the treatment of cervical cancer. Gynecol Oncol 93: 588–593

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University, 30 Gao Tanyan Main Street, Chongqing, 400038, P. R. China

    H. Xu, Y. Chen, Y. Li, Q. Zhang, D. Wang & Z. Liang

Authors
  1. H. Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Y. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y. Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Q. Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Z. Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Z. Liang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Xu, H., Chen, Y., Li, Y. et al. Complications of laparoscopic radical hysterectomy and lymphadenectomy for invasive cervical cancer: experience based on 317 procedures. Surg Endosc 21, 960–964 (2007). https://doi.org/10.1007/s00464-006-9129-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-006-9129-0

Keywords

Search

Navigation