Resection of the rectal pillar and anterior portion of cardinal ligament 11. Resection of paravaginal tissue 12[r]
(1)1
Laparoscopic Radical Hysterectomy
in
Cervical Cancer
Aranya Yantapant , MD Obtetric – Gynecology Department
Rajavithi Hospital Thailand
Definition
Is a malignant neoplasm arising
from cells originating in the cervix uteri
Most common symptom is
abnormal vaginal bleeding
(2)(3)3
(4)Concurrent chemoradiation
Radiation
Chemotherapy
Stage Treatment
IA1-fertility
-complete family
LEEP or conization Extrafascial hysterectomy IA2- fertility
-complete family
Conization and extraperitoneal lymphadenectomy
Hysterectomy type II with pelvic node lymphadenectomy
IB-IIA Radical hysterectomy with pelvic node lymphadenectomy IIB-IVA
IVB
(5)5
Cancer in Thailand
(6)Laparoscopic surgery
Explor laparotomy
Cervical Cancer in
Rajavithi Hospital
2006-2013 for laparoscopic surgery
LRHND 2010
(7)7
Laparoscopic surgery
Stage Ia1-IB1
CT whole abdomen
Age < 65 years
No contraindications
BMI < 35
stage Ia1 Ia2 Ib1
numbers 17
Procedures TLH LMRHND LRHND
number 17
Blood loss TLH LMRHND LRHND
(8)Complications
Urinary tract infection 1 Tear left ureter 1 Tissue emphysema 1
Operative time TLH LMRHND LRHND
hours 3.4-7.3(4.8) 4.45-5.25(4.85) 4.14-8(5.53)
Hospitalization TLH LMRHND LRHND
days 3-9(9.8) 4-9(6.5) 5-22(12.8)
Follow up TLH LMRHND LRHND
(9)9 Recurrence
IB1 27-7
27-18 Pelvic node metastasis
11-8
(10)1 uterine elevator
2 intraabdominal organ evaluation 3 development of the paravesicle and pararectal spaces
4 Pelvic lymphadenectomy 5 Mobilization of the bladder from the proximal vagina
(11)11 7 Ligation and division of the uterine
artery
8 Dissection of the vesicouterine ligament 9 Posterior dissection showing
uterosacral ligament and rectovaginal space
(12)