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The Effect of Uterine Manipulator on Peritoneal Cytology Positivity in Endometrial Cancer: A Prospective
Ceren Gerçek1,2, Hande Nur Öncü2, Tuğba Taşkın Türkmenoğlu3
1Department of Obstetrics and Gynecology, Ankara Etlik City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.
Aim:
There are studies suggesting that the use of a uterine manipulator during minimally invasive surgery (MIS) may lead to tumor spread in endometrial cancer patients, and there is no clear consensus on the safety of uterine manipulator use. The aim of this study was to investigate the effect of uterine manipulator use on peritoneal cytology (PC) results obtained before and after hysterectomy in endometrial cancer patients.
Methods:
A single-center, prospective observational study was conducted, including 108 patients who were diagnosed with endometrial cancer and underwent surgical intervention. The patients were divided into three groups: Group 1 (n = 36), total abdominal hysterectomy (TAH); Group 2 (n = 41) laparoscopic hysterectomy with intrauterine manipulator (TLH with IUM); and Group 3 (n = 31) laparoscopic hysterectomy without IUM (TLH without IUM). PC samples were taken before and after the hysterectomy, and cytology results were compared among the groups.
Results:
Of the 108 patients included in the study, 33.3% (36/108) were in Group 1, 38% (41/108) were in Group 2, and 28.7% (31/108) were in Group 3. The clinical and demographic data among the groups were similar (p > 0.05). PC was positive in six of the 108 patients. In the TLH with IUM group, one patient with a negative cytology sample before the manipulation showed a positive result after the hysterectomy.
Conclusions:
Although statistical significance was not reached, utilizing an IUM to manage endometrial cancer with MIS may enhance cytology positivity. This finding requires further validation through larger prospective studies.
