Objective: In postmenopausal women, the cervix atrophies and retracts, thus making conization increasingly difficult, and results in a tissue specimen that is frequently inadequate. Total hysterectomy is recommended in patients with positive conization margins or cervical intraepithelial neoplasia (CIN) who do not desire children. In such patients, we performed total laparoscopic hysterectomy (TLH). The aim of this analysis was to confirm the efficacy of TLH for the treatment of CIN.
Methods: The medical records of 39 patients who underwent TLH for CIN from August 2013 through December 2015 were examined. The preoperative biopsy sample and postoperative diagnosis were compared. TLH was performed using four trocars placed in a diamond configuration in the same manner as that for benign diseases. In principle, we used uterine manipulators. During vaginal incision, a vaginal pipe was inserted. Data on uterine weight, surgery time, and blood loss were extracted from the medical charts of all patients.
Results: The mean age of the patients was 50.5 years (range, 35-76 years), and 53.8% were postmenopausal. Among the 39 cases, 23 (59.0%) had the same pathological results, and 7 (17.9%) were undervalued by biopsy. In 8 cases, pathological assessment was extremely difficult or impossible because of crush artifacts and other factors. There was no persistence or recurrence of CIN after TLH. The average uterine weight was 139±162 g, surgery time was 119±41 minutes, and blood loss was 57±228 mL.
Conclusion: The results showed that TLH is almost identical to hysterectomy in terms of therapeutic efficacy, and that it should be accepted as a treatment for CIN. Our data suggested that adequate colposcopy is considered necessary for the accurate diagnosis of cervical lesions. It is necessary to recognize that pathological assessment is occasionally difficult.
