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Objective To investigate the application value of transumbilical single-port total laparoscopic hysterectomy by conventional instrument without uterine-lifting in the treatment of cervical lesions.Methods We selected 60 cases of total laparoscopic hysterectomy due to cervical high-grade squamous intraepithelial lesion(HSIL)or cervical cancer stage ⅠA1 from December 2021 to June 2023.According to the patients'preference,30 cases of single-port laparoscopy through the umbilicus and 30 cases of multi-port laparoscopy were performed,both using conventional instruments without uterine-lifting.The surgical indicators of the two groups were compared.Results No conversion to open surgery occurred in both groups,and no intraoperative injuries to the urinary system,bowel,or major blood vessels occurred.As compared with the multi-port group,the single-port group had significantly reduced amount of bleeding during surgery[(54.6±20.5)ml vs.(67.5±27.0)ml,P = 0.041],earlier anal exhaust time[(27.6±8.0)h vs.(32.2±9.0)h,P =0.040],and shorter total hospitalization time[(4.4±1.5)d vs.(5.1±1.2)d,P = 0.044].There were no significant differences in uterine weight,surgical time,and postoperative complications between the two group(P>0.05).The healing of the abdominal wall puncture wounds in both groups of patients were satisfied.There were no short-term complications related to the puncture device(such as puncture wound infection and bleeding)or long-term complications(such as umbilical hernia and incisional hernia).Conclusion Transumbilical single-port total laparoscopic hysterectomy without uterine-lifting presents advantages of less intraoperative bleeding,faster postoperative recovery,and almost no scarring,with complications similar to traditional laparoscopic surgery.
RESUMEN
Objective To evaluate the feasibility and safety of vaginal enlarged amputation of cervix to treat patients with cervical cancer of stage Ⅰ a1 and cervical intraepithelial neoplasia grade Ⅲ(CIN Ⅲ)who were unfit for conization surgery.Methods From July 2002 to May 2007,patients with cervical cancer at stage Ⅰ a1,diagnosed by pathology after loop electrosurgical excision procedure(LEEP),large area CIN Ⅲ(the area of lesion≥3/4 on colposcopy),CIN Ⅲ coexisted with vaginal intraepithelial neoplasia (VAIN)in the superior segment of vagina,CIN Ⅱ-Ⅲ recurrence or with residual lesion,positive margin after conization of cervix,who wanted to preserve fertility and(or)corpus uteri were selected to receive vaginal enlarged amputation of cervix.Results Forty-eight eases including 5 with cervical cancer in stage Ⅰ a1,38 with large area CIN Ⅲ(9 with gland involvement),2 with residual lesion and 2 with positive margin after LEEP,1 recurrence after cold knife conization,received the procedure successfully.The median age was 34 years(range 27-40),median operation time was 60 minutes(range 30-100),median blood loss was 40 ml(range 5-300),and median hospital stay was 10 days(range 7-17).After follow-up 1-39 months,no patient had postoperative complications and recurrence,and all patients resumed normal menstrual cycle and sexual life.Condusion Vaginal enlarged amputation of cervix appears to be a safe and feasible procedure for patients with cervical cancer at stage Ⅰ a1 and CIN Ⅲ who are unfit for conization surgery.