PDF(Pubmed)
Abstract：
In the Laparoscopic Approach to Cervical Cancer trial, minimally invasive surgery (MIS) has been associated with significantly lower disease-free survival and overall survival rates. The proposed reasons for the increased recurrence and mortality associated with MIS are uterine manipulation, the effect of insufflation gas (CO2), and intracorporeal colpotomy. We applied 2 techniques during surgery to reduce tumor spillage in laparoscopic radical hysterectomy (LRH), which included avoiding using a uterine manipulator and containing the colpotomy using an endoscopic stapler. We aimed to introduce an easy and comfortable traction method with tagged uterine sutures instead of a manipulator or vaginal tube for minimally invasive radical hysterectomy (RH). The patient underwent LRH. After entering the peritoneal cavity, tubal ligation was performed with an endoscopic clip to prevent tumor spillage via the fallopian tubes. Then, the uterine fundus was tied with needle-straightened multifilament Vicryl 2-0, and the tagged uterus was manipulated. Thereafter, pelvic lymphadenectomy was performed before RH. Thereafter, we performed intracorporeal colpotomy by resecting the vagina twice using an endoscopic stapler. Finally, the stapled vaginal stump was resected to retrieve the specimen via the vaginal opening using monopolar scissors after the vagina was washed several times with sterile water. After removing the specimen, the vaginal stump was endoscopically closed with a barbed suture. LRH can be feasibly performed in patients with uterine cervical neoplasm by retracting tagged uterine sutures without the use of a uterine manipulator.
摘要：
在腹腔镜下宫颈癌试验中，微创手术(MIS)的无病生存率和总生存率显著降低.与MIS相关的复发和死亡率增加的拟议原因是子宫操作，吹入气体(CO2)的影响，和体内结肠切除术.我们在腹腔镜根治性子宫切除术（LRH）中应用了两种技术来减少肿瘤的溢出，其中包括避免使用子宫操纵器和使用内窥镜吻合器进行结肠切除术。我们旨在引入一种简单舒适的牵引方法，该方法带有标记的子宫缝线，而不是用于微创根治性子宫切除术（RH）的操纵器或阴道管。患者接受LRH。进入腹膜腔后,输卵管结扎术采用内窥镜夹以防止肿瘤通过输卵管溢出。然后，用针拉直复丝Vicryl2-0绑扎子宫底部,并操作标记的子宫.此后,RH前进行盆腔淋巴结清扫术。此后,我们使用内窥镜吻合器两次切除阴道进行了体内结肠切除术。最后,在用无菌水冲洗阴道几次后，使用单极剪刀通过阴道口切除缝合的阴道残端以取回标本。取出试样后,阴道残端用带刺缝线在内窥镜下闭合。通过在不使用子宫操纵器的情况下缩回标记的子宫缝合线，可以在子宫宫颈肿瘤患者中进行LRH。
