Microlaparoscopy: a further development of minimally invasive surgery for endometrial cancer staging -- initial experience.

Objectives: To present our initial experience with micro-laparoscopy in the surgical treatment of endometrial cancer and to compare its outcomes with those of conventional laparoscopic approach.

Methods: Consecutive patients undergoing surgical staging of endometrial cancer using exclusively 3-mm working ports and a 3- or 5-mm laparoscope at the umbilicus (microlaparoscopy group; N=23) were compared with historical controls selected from consecutive women who have had staging with conventional laparoscopy (N=80).

Results: No difference was found in demographics and preoperative variables between the two groups. Conversion from microlaparoscopy to a conventional laparoscopic technique occurred in two cases (9.7%), while there was no conversion to open surgical staging in either group. There were no significant differences between the microlaparoscopy group and the control group with regard to estimated blood loss [100 (10-400) vs. 100 (10-400), P=0.09], number of pelvic lymph nodes (19.2+/-7.4 vs. 18. 6+/-7.2, P=0.79), and complication rate (intraoperative: 0% vs. 2.5%, P=1.0; postoperative: 8.7% vs. 13.7%, P=0.73). Operative time was similar between groups when analysis was restricted to the last 20 conventional procedures performed period prior to beginning of the microlaparoscopy trial [155 (110-300) vs. 160 (115-295), P=0.17]. The median length of hospital stay was 2 (1-10) days for women undergoing microlaparoscopic procedures compared to 3 (1-15) days for those undergoing conventional laparoscopy (P=0.001).

Conclusions: These preliminary results suggest that microlaparoscopy is a safe and adequate surgical option for endometrial cancer staging, with the potential to further decrease invasiveness of the conventional laparoscopic approach.