Optimizing outcomes in minimally invasive radical hysterectomy: the protective role of a vaginal pipe

Following the 2018 LACC trial, minimizing intraoperative tumor spillage during minimally invasive radical hysterectomy (MIRH) became critical in early-stage cervical cancer. This study investigated whether a vaginal pipe reduces tumor spillage and recurrence during MIRH.

We retrospectively reviewed International Federation of Gynecology and Obstetrics 2018 stage IA1-IIA2 cervical cancer patients undergoing radical hysterectomy (2014-2022). Of 216 patients, 35 underwent abdominal radical hysterectomy and 181 underwent MIRH, subdivided by vaginal pipe usage: vaginal pipe group (MIRH-Y, n=77) and non-use group (MIRH-N, n=104).

Baseline characteristics differed only in age (p=0.004) and tumor size (p=0.003). No significant differences were found in 2-year disease-free survival (DFS, p=0.578) or 5-year overall survival (p=0.532). Recurrence occurred in 3 (3.9%) patients in MIRH-Y vs. 12 (11.5%) in MIRH-N. In multivariate Cox regression adjusting for age and tumor size, vaginal pipe use showed a marginal trend toward reduced recurrence (adjusted hazard ratio [HR]=0.31; 95% confidence interval [CI]=0.09-1.09; p=0.068), consistent with inverse probability of treatment weighting (IPTW) analysis (HR=0.36; 95% CI=0.13-1.04; p=0.058). Patients with tumors ≤2 cm showed favorable DFS in the MIRH-Y group (p=0.037), whereas no differences were observed in tumors >2 cm.

In this exploratory analysis, vaginal pipe use during MIRH was associated with a non-significant trend toward lower recurrence, with a statistically significant DFS difference only in tumors ≤2 cm. Because these associations did not reach statistical significance, these hypothesis-generating findings warrant prospective confirmation before the device can be recommended as a routine surgical adjunct.