TOTAL LAPAROSCOPIC RADICAL HYSTERECTOMY AND BILATERAL PELVIC LYMPHADENECTOMY USING THE HARMONIC SCALPEL

N.P. Nagarsheth, M. Prasad, and F. Nezhat

Mt. Sinai Hospital, New York, NY

OBJECTIVE:  The purpose of the following video case presentation is to display the feasibility of a total laparoscopic radical hysterectomy and bilateral pelvic lymphadenectomy with specific use of the harmonic scalpel.  The advantages of this laparoscopic instrument are illustrated.

 MATERIALS AND METHODS:  A 30-year old female, para 0, was found to have adenocarcinoma on a Pap smear with invasive disease on subsequent endocervical curettage.  Cone biopsy and repeat endocervical curettage revealed adenocarcinoma in situ with foci of microinvasion consistent with a stage IA2 lesion.  Radical trachelectomy versus radical hysterectomy was discussed with the patient, however she did not desire future fertility.  Options of laparoscopic versus laparotomy for radical hysterectomy and bilateral pelvic lymphadenectomy were discussed, and the patient wished to proceed with the laparoscopic approach.  The operative time of surgery was 4 hours and 45 minutes with an estimated blood loss of 100 cc.  Surgical techniques employing the harmonic scalpel are demonstrated with dissection of the pelvic spaces, unroofing of the ureter, as well as bilateral pelvic lymphadenectomy. 

RESULTS: There were no intraoperative or postoperative complications and the patient was discharged home on postoperative day 2 with a Foley catheter and leg bag, which was then removed in the office on postoperative day 5 after a minimal post-void residual was documented.   Final pathology showed residual adenocarcinoma in situ with negative margins and 34 pelvic lymph nodes, all of which were negative.

CONCLUSIONS:  Total laparoscopic radical hysterectomy with bilateral pelvic lymphadenectomy is a feasible and safe procedure.  The advantages include shorter hospital stay and accelerated recovery period compared to laparotomy.  In addition, the harmonic scalpel has the benefits of functioning as a grasper, dissector, coagulator, and cutting device, thus minimizing the need for instrument exchange and shortening operative time.  Further advantages of the harmonic scalpel include generation of less smoke and coagulation of the tissue at lower temperatures with minimal thermal spread to lateral tissue than with traditional electrocautery or laser surgery.

Key Words:  harmonic scalpel, total laparoscopic radical hysterectomy, pelvic lymphadenectomy 

Disclosure – Nothing to disclose.