Laparoendoscopic Single-Site Radical Hysterectomy and Pelvic Lymph Node Dissection with Transvaginal Natural Orifice Specimen Extraction for Cervical Cancer

Abstract

Over the course of development in traditional surgery, surgical scars and pain have been considered unavoidable by-products of surgery. However, in recent years, the emergence of natural orifice transluminal endoscopic surgery (NOTES), in which visceral surgery can be accomplished without a body surface approach, has radically altered this notion. As a cutting-edge technique in the era of minimally invasive surgery, NOTES is representative of the new goal in surgery. The basic concept of NOTES is performing operations wherein access to the abdominal cavity is gained via an incision in a natural cavity to avoid abdominal scars, which will result in reduced postoperative pain, more minimally invasive operations, and enhanced cosmetic outcomes. The umbilicus is a natural orifice during the fetal stage, and persists as an inherent scar in the human body. It can be used to hide abdominal scars and to avoid problems with transgastric, vaginal, and rectal infections. Therefore, laparoendoscopic single-site surgery (LESS) can also be regarded as a form of NOTES.

The application of LESS in the treatment of benign gynecological tumors has been gradually increasing, while its application in more complex gynecological surgeries (e.g., surgery for endometriosis and cervical cancer) has also been reported in the recent years. Although controversies surrounding this technique persist, several studies have demonstrated the feasibility and safety of LESS. As long as the surgeon adheres to the surgical indications and is equipped with the required surgical proficiency, this technique is scientifically rational, safe, and feasible.