Improving uterine manipulation techniques in laparoscopic hysterectomy
image: Traditional and modified uterine manipulator for patients with early-stage cervical cancer. (A) Traditional UM including UM pole, UM cup; (B) assembled traditional UM; (C) improved UM without UM pole.
Credit: All authors (Yu-Shu Sun et al.)
Laparoscopic radical hysterectomy has been a preferred option for early-stage cervical cancer due to reduced blood loss, shorter hospital stays, and fewer complications compared to traditional open surgery. However, concerns have emerged about the safety of minimally invasive approaches, particularly regarding the role of traditional uterine manipulators in spreading tumor cells during surgery.
Researchers from Fudan University, Shanghai, have developed a modified uterine suspension method (USM) that eliminates the use of traditional intrauterine devices, addressing concerns over postoperative complications and potential tumor cell spread.
The study, involving 100 patients treated between 2015 and 2019, compared traditional uterine manipulators with the new method. The study found that patients in the new method group experienced significantly fewer postoperative complications.
The modified USM involves suspending the uterine fundus with a suture fixed to the abdominal wall, eliminating the need for the intrauterine pole. A specially designed uterine cup is then used to aid in identifying the vaginal vault and maintaining pneumoperitoneum during surgery.
By avoiding direct intrauterine operations, this approach reduces the risk of infection and tumor cell spread. “The design prioritizes safety and simplicity during operation,” said Dr. Yi Xiao-Fang, the corresponding author. “It not only enhances exposure of pelvic anatomical structures but also contributes to a smoother recovery process.”
Beyond cervical cancer, the modified USM could benefit surgeries for other uterine or cervical conditions, particularly those involving infections from the lower anogenital tract. By reducing postoperative complications and enhancing recovery, this technique represents an innovative advancement in gynecological surgery.
However, the authors also acknowledged limitations in their research, including the retrospective design and relatively short follow-up period for patients treated with the new method. “Further large-scale, multi-center studies are needed to further validate these findings and explore broader applications,”added Dr. Yi.