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Laparoscopic Modified Radical Hysterectomy and Lymphadenectomy Simulating Open Operation for Stage 1A2 Cervical Carcinoma
Author(s) -
Jobling T.,
Wood C.
Publication year - 1993
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1993.tb02121.x
Subject(s) - medicine , radical hysterectomy , cervical cancer , cervix , general surgery , lymphadenectomy , radical surgery , gynecologic oncology , hysterectomy , blood loss , informed consent , stage (stratigraphy) , surgery , cervical carcinoma , laparoscopic surgery , laparoscopy , cancer , paleontology , alternative medicine , pathology , biology
EDITORIAL COMMENT": This paper gives a fine technical description of a modified radical procedure performed laparoscopically for a very early carcinoma of the cervix. The initial results of the operation in terms of blood loss and time in hospital are impressive. The paper does not however attempt to answer what we think are the most important issues raised by the advent of laparoscopic surgery. Unfortunately the comparison of open and laparoscopic surgery for gynaecological cancer cannot be measured in terms of immediate postoperative morbidity or mortality. The efficacy of this treatment can only be ascertained in following up these patients over several years and determining overall survival and tumour recurrence patterns. That being the case it is difficult to see how informed consent can be obtained from patients undertaking laparoscopic procedures for gynaecological cancer. We are not able to tell these patients that overall cure rates are as good as with conventional therapy and the potential for litigation looms high should this turn out not to be the case. One would expect the results of treatment for the patient presented in this paper to be excellent, as many would consider that a simple hysterectomy would have been adequate therapy. While these patients with very early lesions may be suitable candidates to refine the technique needed for this radical surgery once again the problem of informed consent is a concern. This is such a problem that the Gynecologic Oncology Group in the United States of America is holding a workshop to consider the ethical issues raised by laparoscopic surgery for gynaecological cancer. We believe that there is a place for radical laparoscopic surgery but are equally certain that its place has not yet been defined. Summary: A 31 year old patient with Stage 1A2 cervical carcinoma underwent a laparoscopically modified radical hysterectomy and pelvic lymphadenectomy simulating the open operation. The operative technique is described. The operative time was 7 hours and 40 minutes. The patient was discharged on the third post‐operative day. The procedure warrants further evaluation.