Complete laparoscopic hysterectomy utilised the marionette technique in peri-menopausal and post-menopausal females with CIN3

Abstract

Background:  The incidence of postoperative cervical stenosis and the positive rate of endocervical cone margin rise when cervical conization is performed on individuals with postmenopausal cervical intraepithelial neoplasia 3 (CIN3). This study intends to provide an overview of total laparoscopic hysterectomy as a therapeutic choice for CIN3 patients who are perimenopausal or postmenopausal at a single hospital over a period of 4 years.

Methods: The purpose of this study was to conduct an analysis of medical records from approximately 44-year-old CIN3 patients who underwent open or laparoscopic hysterectomy at our institution between 2017 and 2020 in a retrospective manner. Out of a total of 60 CIN3 patients, 10 were assigned to abdominal total hysterectomy (ATH) group and 50 to total laparoscopic hysterectomy group (TLH).

Results: The laparoscopic hysterectomy group experienced a substantially shorter in-hospital stay (6 days vs. 10 days, p < 0.001) and perioperative blood loss (18 mL vs. 218 mL, p = 0.003) than the abdominal hysterectomy group. Neither the operating length (153.40 ± 26.80 min vs. 160.0 ± 61.40 min, p = 0.825) nor the age at hysterectomy (52 y vs. 76 y, p = 0.053) showed a significant difference between the two groups. 20 patients (or 83.30% of the total) who had diagnostic conization done prior to the procedure had endocervical cone margins that were positive .Two patients who had an abdominal hysterectomy experienced postoperative intestinal obstruction; the other patients showed no significant problems.

Conclusion: For perimenopausal and postmenopausal CIN3 patients, hysterectomy is a suitable therapeutic option, albeit being more intrusive than conization. Due to its less invasive nature, a total laparoscopic hysterectomy with the marionette approach may be the better option in these situations.