Laparoscopically assisted schauta operation: Learning experience at the Gynecologic Oncology Unit, Buenos Aires University Hospital

Objectives. The aim of this study was to show the learning experience of th e employment of laparoscopic lymphadenectomy followed by a Schauta operatio n to treat patients with cervical carcinoma at a university hospital and to evaluate the feasibility, complications, hospital stay, delay in return to work, and overall survival of this procedure. Methods. Between June 1, 1993, and December 30, 1997, 56 patients were sele cted. Surgical treatment began with a pelvic laparoscopic lymphadenectomy f ollowed by a Schauta operation. Patients were staged according to FIGO crit eria (Ia2, 10 cases; Ib1, 33 patients; Ib2, 8 cases; IIa, 3 cases; and IIb, 2 patients). Patients had a follow-up of 47 months. Overall survival was c alculated with Kaplan-Meier tables. Results. The procedure was not completed in 9 pts, in 5 cases among the fir st 20 pts that were entered on the trial due to technical problems and in 4 due to extracervical spread of disease (2 with gross laparoscopically unre sectable lymph node metastases, 1 with parametrial infiltration, and 1 with rectovaginal septum involvement). In the 47 pts in which the procedure cou ld be completed, the laparoscopic approach was done in 102 min and the vagi nal part in 165 min. There were 4 complications: 1 ureteral injury, 1 absce ss of the ischiorectal fossa, 1 hematoma of the Schuchardt incision, and 1 case of leg edema. The mean number of resected nodes was 17. Among the 47 c ases in which the surgical procedure was completed, overall survival was 10 0% for Stage Ia, 88% for Ib1, and 85% for Ib2 after a mean follow-up of 4 y ears. Four pts have relapsed and died; 3 were stage Ib1 and the other was s tage Ib2. They had pelvic recurrences. Conclusions. This surgery is secure and has an excellent outcome, so it can be considered a valid approach for the treatment of patients with cervical carcinoma, but in our hands, 20 cases were needed to obtain the minimum sk ill needed to perform it. (C) 1999 Academic Press.