Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute, Orlando, FL 32804, USA.
Gynecol Oncol. 2012 Oct;127(1):98-101. doi: 10.1016/j.ygyno.2012.07.094. Epub 2012 Jul 16.
Uterine manipulators are a useful adjunct for robotic-assisted radical hysterectomy (RARH), but some surgeons avoid their use for fear of altering pathology or interpretation of lymphovascular space involvement (LVSI). We retrospectively compared clinico-pathological data and tumor pathology from patients with cervical cancer operated by laparotomy vs. RARH.
Charts from cervical cancer patients who underwent radical hysterectomy from January-1997 to June-2010 were reviewed for tumor histology, grade, FIGO stage, lymph node status, LVSI, depth of invasion, and tumor size. A ConMed V-Care® uterine manipulator was used in all robotic cases. H&E stained slides from 20 robotic and 24 open stage IB1 cases with LVSI reported in the original pathology were re-reviewed by a blinded pathologist for analysis of tissue artifacts and LVSI.
Two-hundred-thirty-six cases (185 open, 51 robotic) with stages IA2, IB1 and IB2 cervical cancer were reviewed. No significant differences in histology (squamous cell carcinoma, 65% vs. 51%; p=0.1), IB1 lesion size (≤2 cm, 62% vs. 61%, p>0.1), LVSI (34% vs. 39%, p>0.1), and depth of stromal invasion (p>0.1) was found between open and robotic groups. Histologic examination of all IB1 cervical carcinomas revealed a higher degree of surface disruption [45% (9/20) vs. 12.6% (3/24), p=0.038] and artifactual "parametrial carryover" [65% (13/20) vs. 29% (7/24), p=0.037] in robotic vs. open groups, respectively, but no significant differences in the rate of LVSI.
RARH cases that utilized a uterine manipulator did not show any clinico-pathological differences in depth of invasion, LVSI, or parametrial involvement compared to open cases.
子宫操纵器是机器人辅助根治性子宫切除术（RARH）的有用辅助工具，但由于担心改变病理学或解释淋巴管血管空间侵犯（LVSI），一些外科医生避免使用它们。我们回顾性比较了经剖腹手术与 RARH 手术治疗的宫颈癌患者的临床病理数据和肿瘤病理学。
回顾性分析 1997 年 1 月至 2010 年 6 月接受根治性子宫切除术的宫颈癌患者的病历，分析肿瘤组织学、分级、FIGO 分期、淋巴结状态、LVSI、浸润深度和肿瘤大小。所有机器人手术均使用 ConMed V-Care®子宫操纵器。对 20 例机器人手术和 24 例 LVSI 阳性的 IB1 期宫颈癌患者的 H&E 染色切片进行重新分析，由一位盲法病理学家分析组织学伪影和 LVSI。
共分析了 236 例 IA2、IB1 和 IB2 期宫颈癌患者（185 例开腹手术，51 例机器人手术）。两组患者的组织学（鳞状细胞癌，65%比 51%；p=0.1）、IB1 病变大小（≤2cm，62%比 61%；p>0.1）、LVSI（34%比 39%；p>0.1）和间质浸润深度（p>0.1）均无显著差异。对所有 IB1 期宫颈癌患者的组织学检查显示，机器人组的表面破坏程度更高[45%（9/20）比 12.6%（3/24），p=0.038]，人工“宫旁转移”更多[65%（13/20）比 29%（7/24），p=0.037]，但 LVSI 发生率无显著差异。
与开腹手术相比，使用子宫操纵器的 RARH 病例在浸润深度、LVSI 或宫旁侵犯方面没有任何临床病理差异。
