Urologic Complication after Laparoscopic Hysterectomy in Gynecology Oncology: A Single-Center Analysis and Narrative Review of the Literature

Laparoscopic Resection of Central Ovarian Cancer Recurrence in the Pelvis Utilizing a Fluorescent Ureteral Near-Infrared Ray Catheter (NIRC): A Case Report

The central recurrence of ovarian cancer at the vaginal stump requires anterior pelvic resection if there is an invasion into the bladder triangle. There is a lack of evidence regarding the efficacy of minimally invasive surgery for recurrent ovarian cancers. Therefore, there are no reports of using a fluorescent ureteral near-infrared ray catheter (NIRC) (Cardinal Health Ltd., Tokyo, Japan) in laparoscopic surgery for recurrent ovarian cancers. We reported a 51-year-old woman who underwent laparoscopic resection for recurrent ovarian cancer located on the posterior wall of the vaginal stump, exposed to the vaginal lumen, and invaded the rectum but not the anterior vaginal wall or bladder. A fluorescent ureteral NIRC for the real-time intraoperative visualization of the ureters allowed laparoscopic resection of the recurrent tumor at the vaginal stump with preservation of the bladder and the ureters.

Meta-analysis reveals higher intraoperative urologic complication rates in minimally invasive radical hysterectomy compared to abdominal radical hysterectomy

BACKGROUND

Minimally invasive radical hysterectomy (MIRH) has been increasingly adopted for its benefits of reduced blood loss and shorter hospital stays. This study aims to conduct a meta-analysis to compare the incidence of intraoperative urologic complications, including bladder and ureteral injuries, between MIRH and abdominal radical hysterectomy (ARH).

METHOD

The authors systematically searched PubMed, EMBASE, and the Cochrane Library for studies published up to April 2024. A total of 35 studies were analyzed to compute odds ratios (ORs) for intraoperative urologic complications, bladder injuries, and ureteral injuries, focusing on subgroup evaluations by publication year, study quality, BMI, geographic region, and surgical method.

RESULTS

The meta-analysis demonstrates that MIRH is associated with higher risks of intraoperative urologic complications (OR=2.412, 95% CI: 1.995-2.916, P <0.001), bladder injuries (OR=2.109, 95% CI: 1.567-2.839, P <0.01), and ureteral injuries (OR=2.549, 95% CI: 1.992-3.262, P <0.001). No publication bias was detected across the studies, ensuring the robustness of the findings. Significant differences in complication rates were also observed across geographic and procedural subgroups.

CONCLUSION

The findings confirm that MIRH has a higher rate of intraoperative urologic complications, including bladder and ureteral injuries, compared to ARH. These results provide essential insights that could guide clinical decision-making and influence surgical practice guidelines.

Evaluation of the benefit of indocyanine green as an educational and practical tool for ureteral identification in laparoscopic pelvic surgery: a cross-sectional study

BACKGROUND

Indocyanine green (ICG) is a visible near-infrared fluorescent dye. Several studies have reported its benefit in identifying important anatomical structures, tissue vascularization, and sentinel lymph nodes in the case of tumors. Studies have shown that ICG is critical and safe in gynecologic surgeries. However, research on how ICG dye can help surgeons in laparoscopic surgeries correctly identify the course of the ureter has yet to be further investigated.

METHOD

This cross-sectional study enrolled 62 gynecology attending and resident surgeons who were asked to identify the course of the ureter on images of laparoscopic surgeries. The results were then compared with images in which ICG dye highlighted the course of the ureter. The purpose of this study was to detect the ability of surgical assistants and residents to adequately identify the course of the ureter in laparoscopic pelvic surgeries.

RESULTS

No statistically significant differences were found in terms of year of residency, years of experience, number of laparoscopic procedures attended, and correct identification of ureter course. ICG proved useful in identifying the correct ureteral trajectory.

CONCLUSIONS

ICG can be a valuable tool to improve the correct identification of ureters and improve surgical outcomes.

Clinical implications of the superficial uterine vein pattern for the dissection of the anterior layer of the vesicouterine ligament in radical hysterectomy

OBJECTIVE

To describe anatomic patterns of the superficial uterine vein (sUV) and assess their association with aspects of the dissection procedure of the anterior layer of the vesicouterine ligament (aVUL) by retrospectively reviewing surgical videos.

METHODS

We analyzed patients who underwent laparoscopic radical hysterectomy for early-stage cervical cancer from 2014 to 2019. The primary endpoint was the time required for aVUL dissection. Multiple linear regression analyses were performed to identify factors influencing the time required for aVUL dissection.

RESULTS

Fifty-three Japanese patients were included. Two sUV configurations were observed: type 1 (the vein ran ventral to the ureter along the uterine artery) and type 2 (the vein did not run along the usual ventral course; it ran dorsal to the ureter or was absent). Approximately 30% of the sUVs were type 2. The total time for dissection of both sides of the aVUL was significantly shorter for type 2 sUVs than for type 1 sUVs. The number of hemostatic interventions during dissection of each side of the aVUL was significantly lower for type 2 sUVs than for type 1 sUVs. In the multivariate analysis, the sUV configuration was the factor significantly influencing the duration of aVUL dissection on each side (right side: β=-143.4; left side, β=-160.4).

CONCLUSION

We demonstrated that the sUV had 2 types of courses, ventral and others, and its course affected the time required for dissection and the number of hemostatic interventions. Our results provide information supportive of improved radical hysterectomy outcomes.

OS and DFS are affected by different diagnostic methods and hysterectomy procedures in endometrial cancer patients: A single-center retrospective study

PURPOSE

We aimed to evaluate whether hysteroscopy increases the risk of intraperitoneal dissemination or worsens the prognosis of endometrial carcinoma (EC) patients and whether radical hysterectomy (RH) improves overall survival (OS) or disease-free survival (DFS) in patients with stage II to III EC and to investigate the effects of different procedures for identifying EC and the effects of different surgical methods on the OS and DFS of endometrial cancer patients.

METHODS

Four hundred sixty-five women with EC were included in this retrospective study. Log-rank tests and Kaplan-Meier analysis were used for the outcome comparisons of the effects of the EC diagnostic method and different hysterectomy procedures. A Cox proportional hazards model was used for univariate regression analysis.

RESULTS

Among the three procedures for diagnosing EC (diagnostic curettage, hysteroscopy, and hysterectomy), the incidences of fallopian tube and ovarian invasion were not significantly different (p = 0.506 and 0.066, respectively). The diagnostic methods for EC had no significant effect on OS (p = 0.577) or DFS (p = 0.294). In addition, type II RH and type III RH did not improve the prognosis of patients with FIGO stage II and III disease (log-rank p = 0.914 and 0.810 for OS; log-rank p = 0.707 and 0.771 for DFS, respectively).

CONCLUSION

Based on the current study evidence, the use of diagnostic hysteroscopy procedures is safe and does not increase the risk of fallopian tube and ovarian invasion of intraperitoneal dissemination or worsen the prognosis of EC patients. Type II and type III RH did not demonstrate a benefit for stage II-III EC patients.

Clinical Relevance of Uterine Manipulation on Oncologic Outcome in Robot-Assisted versus Open Surgery in the Management of Endometrial Cancer

In this study, we investigated the impact of uterine manipulation on endometrial cancer survival outcomes. We analyzed patients with endometrial cancer who underwent robot-assisted staging and open staging surgery between 2010 and 2020. Either uterine manipulators or vaginal tubes were utilized in robot-assisted staging. Propensity score matching was performed to correct baseline characteristics. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier curve analysis. In total, 574 patients, including those undergoing robot-assisted staging with a uterine manipulator (n = 213) or vaginal tube (n = 147) and staging laparotomy (n = 214), were analyzed. Propensity score matching was performed for age, histology, and stage as covariates. Before matching, Kaplan-Meier curve analysis showed that PFS and OS were significantly different among the three groups (p < 0.001 and p = 0.009, respectively). In the propensity-matched cohorts of 147 women, the previously suggested differences in PFS and OS were not observed in patients undergoing robot-assisted staging with a uterine manipulator or vaginal tube or open surgery. In conclusion, robotic surgery using a uterine manipulator or vaginal tube did not compromise survival outcomes in endometrial cancer management.