Laparoscopic assisted radical vaginal hysterectomy versus radical abdominal hysterectomy--a randomised phase II trial: perioperative outcomes and surgicopathological measurements.

摘要

Sir, We applaud Naik et al. for undertaking an RCT in the surgical treatment of early-stage cervical cancer. Clinical recruitment for such an infrequent disease is always problematic and this is reflected in the small numbers of women in this study. We agree that adequate vaginal access is essential for a radical vaginal approach, but question why cervical defects caused by previous large loop excision of the transformation zone (LLETZ) were an exclusion criterion to the study. Almost aE women with invasive cervical cancer considered for definitive surgery will have had at least one loop excision, and often two may have been performed. In the Coelio-Schuata laparoscopic assisted radical vaginal hysterectomy (LARVH) technique the cervix is not grasped directly during the operation, instead a vaginal envelope is created, which is used to manipulate the cervix indirectly. Adequate vaginal access is therefore more relevant than number of previous LLETZ.