Laparoscopic radical hysterectomy with vaginectomy and reconstruction of vagina in patients with stage I of primary vaginal carcinoma

Objectives. The purpose of this study was to retrospectively evaluate the technique, feasibility and oncological safety of laparoscopic radical hysterectomy with vaginectomy and reconstruction of vagina in patients with stage I primary vaginal carcinomas. Methods. Between February 2003 and July 2004, four patients, that had needs of sexual life, aging from 41 to 61 years with stage I primary vaginal carcinoma located at the upper third or 2/3 of the vagina, were submitted to laparoscopic radical hysterectomy with vaginectomy and reconstruction of the vagina using the sigmoid colon. Results. The average operative time was 305 min (range260-350 min). The average estimated blood loss was 325 ml (range 250-400 ml), and the medial number of the lymph nodes removed was 16 (range 13-20). All surgical margins and nodes removed were negative histopathologically. There were no intra-operative and postoperative complications. The mean stay day after surgery was 7 days (range 6-8 days). The mean length of a neovagina was 13 cm (range 12-15 cm) and the introitus admitted two fingers in breadth. The mean follow-up was 46 months (range 40-54 months). All patients are clinically free of disease and have satisfactory sexual life. None require dilation of the introitus. During the first 6 months, all the patients had little complaints of excessive leucorrhoea. Conclusions. To our knowledge, this is the first reported laparoscopical radical surgery combined with reconstruction of the vagina in patients with early-stage primary vaginal cancer. Our results have demonstrated the oncological safety and feasibility of the laparoscopical procedure. Intermediate-term follow-up validates the adequacy of this procedure. (c) 2007 Elsevier Inc. All rights reserved.