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International Journal of Surgical Oncology
Volume 2012, Article ID 263850, 5 pages
http://dx.doi.org/10.1155/2012/263850
Clinical Study

The Retrograde and Retroperitoneal Totally Laparoscopic Hysterectomy for Endometrial Cancer

1Department of Obstetrics and Gynecology, Saint Andrew Hospital Asl 5, La Spezia, Italy
2Dipartimento Materno-Infantile, Ospedale Sant’ Andrea, Asl 5, Via Veneto 134, 19100 La Spezia, Italy
3Department of Gynecologic Oncology, University of Turin, Turin, Italy

Received 24 March 2012; Accepted 20 May 2012

Academic Editor: Constantine P. Karakousis

Copyright © 2012 Eugenio Volpi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. We retrospectively report our experience with the utilization of an original procedure for total laparoscopic hysterectomy based on completely retrograde and retroperitoneal technique for surgical staging and treatment of the endometrial cancer. The surgical, financial, and oncological advantages are here discussed. Methods. The technique used here has been based on a combination of a retroperitoneal approach with a retrograde and lateral dissection of the bladder and retrograde culdotomy with variable resection of parametrium. No disposable instruments and no uterine manipulator were utilized. Results. Intraoperative and postoperative complications were observed in 10% of the cases overall. Operative time length and mean haemoglobin drop value results were 129 min and 125 mL, respectively. Most patients were dismissed on days 3–5 from the hospital. Seventy-eight percent of the patients were alive with no evidence of disease at mean followup of 49 months. Conclusions. Our original laparoscopic technique is based on a retroperitoneal approach in order to rapidly control main uterine vessels coagulation, constantly check the ureter, and eventually decide type and site of lymph nodes removal. This procedure has important cost saving implications and the avoidance of uterine manipulator is of matter in case such as these of uterine malignancy.