Minimally Invasive Total Uterus Excision

Aim: This is a presentation of the laparoscopic total uterus excision, in a patient suffering from papillary serous carcinoma of the uterus with an endocervical canal participation. Case report: A 47 year-old female, which was pregnant three times and gave birth three times (all by C-section), complained of bleeding afer menopausa. Without any cases of cancer in the family interview. Biopsy of the endometrium showed a mixed, low differentiated carcinoma-papillary serous and endometrioid type. Lesion of the cervix was observed and dilation with curettage indicated a low differentiated adenocarcinoma with squamoid characterstic. Because the cervix was involved as well, the patient was adviced modified laparoscopic total uterus removal. All treatment solutions were discussed with the patient and she agreed to staging with a laparoscpic device use. Intervention: There was performed a laparoscopic, modified, total uterus removal with the ovaries and Fallopian tube excision, pelvic lymph nodes resection, and omentectomy. Intervention time was 330 min, blood loss 100cc, without any intraoperative complication. The patient went home on the third day after surgery and the urinary catheter was removed on the 14 day after intervention. Histological examination showed uterine papillary serous carcinoma in a III C stage. After administration of chemotherapy with Taxol, Adriamycin, and Cisplatin, the patient presented without any cancer signs 10 months after the treatment. Conclusions: Laparoscopic modified total uterus removal with staging is a practicable management option for uterine papillary serous carcinoma in an advanced stage. Authors: Farr Nezhat, MD, Connie Liu MD, Dimitry Lerner MD