Laparoscopic complete hysterectomy and pelvic lymphadenectomy in the treatment of endometrial cancer

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Endometrial cancer is a malignant tumor from the lining of the uterus that is common in postmenopausal women. If diagnosed early and treated promptly, the patient has a good prognosis. Treatment of endometrial cancer can be by surgery, radiation therapy, chemotherapy according to each stage of the disease.

1. What is endometrial cancer?

The lining of the uterus is the layer that covers the entire inner surface of the uterus. This is a layer that plays an important role in conception and protection of pregnancy in women. Each menstrual cycle, under the influence of female sex hormones, the endometrium grows thicker, ready to nest for a fertilized egg. The structure of the uterine lining has 2 layers: The basal layer (also called the basal mucosal layer): is usually not affected by the menstrual cycle. The superficial layer (also called the glandular mucosa): is often affected by changes in the menstrual cycle.
Endometrial cancer is increasing and becoming a common gynecological cancer for women. Endometrial cancer is a type of cancer arising from the lining of the uterus, the result of abnormal growth of endometrial cells, these cancer cells have the ability to invade and spread. to another agency.
The first sign to suggest endometrial cancer is abnormal bleeding outside of the menstrual period, especially after menopause.
The prognosis of endometrial cancer is generally good if detected at an early stage.

2. Treatment of endometrial cancer

The primary, best treatment for endometrial cancer is a total hysterectomy, adnexectomy as well as bilateral pelvic lymph node dissection. However, it depends on the diagnosis of endometrial cancer (stage, pathological results, level of invasion, ... After surgery, additional or adjuvant treatments such as radiation therapy, therapy, etc.) Endocrine or chemotherapy to improve treatment efficiency
Surgery includes open surgery and laparoscopic surgery Today, laparoscopic surgery is often applied to help patients recover quickly, leaving no residue. bad scarring on the abdominal wall
Surgery for endometrial cancer usually involves removal of the uterus, fallopian tubes or the entire ovaries. Removed during surgery along with other tissue samples
In case of complete hysterectomy, ovaries are a complex issue and need to be carefully considered because the patient will not be able to get pregnant or give birth.
Indications: Endometrial cancer stage I and II. III.
Contraindication: Cancer of endometrial stage III and IV
There are contraindications to p. endoscopic surgery. People with too large uterus, many adhesions due to repeated old incisions or contraindications to laparoscopic surgery due to systemic diseases.
Advantages: The patient can recover quickly, the hospital stay is short. Does not leave bad scars on the abdominal wall
Cons: This is a difficult technique, so it requires a doctor with experience and well-trained in this technique.

3. Steps to perform laparoscopic complete hysterectomy and lymph node dissection

Step 1: The patient lies in the gynecological examination position, the head is low
Step 2: Proceeding
Stage 1: Tropectomy: Insert the trocar 10 below or above the umbilicus, inject CO2 into the abdomen to a pressure of 15 mmHg, then use the bronchoscope. evaluation of the entire abdomen Stage 2: Dissection of lymph nodes: Cut the round ligament as far as possible from the uterus - cut the uterine ligament of the ovary - if there is an indication for ovariectomy, cut the ovarian lumbar ligament - open the peritoneum parallel to the direction of the external iliac artery - expose the ureter, then dissect the bilateral iliac lymph nodes along the external iliac artery, external iliac vein, internal iliac artery, and internal iliac vein to the obturator fossa to the cord. Obturator nerve 3rd phase: Hysterectomy: Cut the peritoneal leaf in the anterior sacrum, lower the bladder - cut the uterine artery - cut the 2 uterine ligaments and push the rectum down - complete hysterectomy, suture vaginal apex (through endoscopic or vaginal route)- check hemostasis, check ureter, bladder CO2 removal and trocar withdrawal After surgery need to monitor hemodynamic factors, monitor abdomen, vaginal bleeding develops presently Abnormal signs for timely handling Complications that can be encountered after surgery are: Bleeding during and after surgery. Early detection of bleeding to re-operate to stop bleeding, Peritonitis, Gastrointestinal tract injury: Intestine, colon, rectum, Urinary tract injury: Bladder, ureter, Blood vessel injury National General Hospital Vinmec Hospital is currently one of the prestigious addresses in the treatment of gynecological diseases in general. The technique of complete hysterectomy and pelvic lymphadenectomy through laparoscopic surgery at Vinmec will be performed on the modern laparoscopic surgery machine of KSTOR; tissue cutter when the tumor is too large; need to push the uterus for surgery, instruments to close the vagina, modern operating room is fully equipped with modern anesthesia, minimizing the risk of infection, experienced specialists and well-trained in this technique, at the same time, the advantages of laparoscopic surgery will help patients less traumatized, recover quickly, leave very small scars, and especially, the safety is very high compared to surgery. conventional open surgery.

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