Laparoscopic Radical Hysterectomy: A Preliminary Report.

The Laparoscopic Assisted Surgery Program began in 1991 at The Graduate Hospital. Initially, traditional laparoscopic gynecologic procedures were performed including laparoscopic oophorectomy, hysterectomy, and adhesiolysis. We then began staging patients with ovarian and endometrial cancer laparoscopically. Next, a series of patients who underwent laparoscopic extrafascial hysterectomy with lymph node sampling for endometrial cancer was attempted. In June of 1992, we performed what we believe to be the first completely laparoscopic radical hysterectomy and bilateral pelvic and common iliac lymphadenectomy for a stage IB squamous carcinoma of the cervix. To date fourteen of these procedures have been performed with few complications. The complications encountered thus far include narrowing of a right ureter detected by an intravenous pyelogram obtained on postoperative day 10 and a small vesicovaginal fistula. The narrowed right ureter had a retrograde stent placed as a precaution. It would appear that laparoscopic radical hysterectomy in selected patients offers significant advantages in terms of hospitalization, incision size, and wound, pulmonary, and intestinal complications. In addition to the clinical advantages, laparoscopic radical hysterectomy appears to be more cost effective than traditional laparotomy.