Laparoscopic assistance for extended radicality of radical vaginal hysterectomy: Description of a technique

Objective. We developed and standardized a surgical technique, which allows radical hysterectomy by a combined laparoscopic and vaginal approach with radicalness equivalent to a type III procedure according to Rutledge. Method. Thirty-six consecutive patients with cervical cancer stage IB(1)IIIA with high risk for parametrial involvement were treated between May 1996 and March 1998. Results. Bilateral para-aortic and pelvic lymphadenectomy and resection of the cardinal ligaments was performed laparoscopically using bipolar coagulation. Dissection of the ureters and resection of bladder pillars and uterosacral ligaments was performed transvaginally. On average 6.5 cm of cardinal ligament could be removed per side. Conclusions. With the laparoscopic-vaginal technique described a radical hysterectomy type III can be performed. (C) 1998 Academic Press.