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Laparoscopic nerve-sparing radical vaginectomy in patients with vaginal carcinoma: surgical technique and operative
Yuyan Li1, Yong Chen, Huicheng Xu
1Department of Gynecology and Obstetrics, Southwest Hospital, Third Military Medical University, Chongqing, China.
Study Objectives:
To describe our technique for laparoscopic nerve-sparing radical vaginectomy and to assess the feasibility and safety of the procedure via operative outcomes.
Design:
Retrospective study (Canadian Task Force classification II-2).
Setting:
Major university teaching hospital in Chongqing, China.
Patients:
Twelve consecutive patients with early stage vaginal carcinoma.
Interventions:
Laparoscopic radical parametrectomy/vaginectomy with pelvic/paraaortic lymphadenectomy.
Measurements And Main Results:
Nerve-sparing radical vaginectomy was completed laparoscopically without conversion to laparotomy in 12 patients with early stage vaginal cancer. Mean (SD) operative time was 158.5 (36.7) minutes, and estimated blood loss was 135.2 (62.8) mL. No intraoperative complications occurred, and no patients required blood transfusion. The number of pelvic nodes obtained was 21.2 (9.8), and of para-aortic nodes was 13. All nodes were negative for malignancy. Histologic analysis confirmed the absence of any residual cancer tissue in the margins of the parametrial tissue and vagina. The median (range) time before Foley catheter removal was 9.76 (3-14) days, and bladder void function recovery to grade 0-I was observed in 11 patients (91.7%). Neither long-term bladder voiding dysfunction nor any other long-term complications were reported. The median duration of follow-up was 28 months. One patient with stage II vaginal cancer received pelvic regional radiation therapy; the other patients did not require adjuvant therapy after the operation. All patients were included in the follow-up protocol, and there was no recurrence of disease in any patients.
Conclusions:
Laparoscopic radical parametrectomy/vaginectomy with pelvic/para-aortic lymphadenectomy is a therapeutic option for early stage vaginal carcinoma. Nerve-sparing radical surgery in indicated patients may lead to optimal preservation of bladder function. The technique described in this preliminary study seems to be safe and feasible, and was relatively easy to perform in our study population.
