Does a uterine manipulator affect cervical cancer pathology or identification of lymphovascular space involvement?

ObjectiveUterine manipulators are a useful adjunct for robotic-assisted radical hysterectomy (RARH), but some surgeons avoid their use for fear of altering pathology or interpretation of lymphovascular space involvement (LVSI). We retrospectively compared clinico-pathological data and tumor pathology from patients with cervical cancer operated by laparotomy vs. RARH.MethodsCharts from cervical cancer patients who underwent radical hysterectomy from January-1997 to June-2010 were reviewed for tumor histology, grade, FIGO stage, lymph node status, LVSI, depth of invasion, and tumor size. A ConMed V-Care® uterine manipulator was used in all robotic cases. H&E stained slides from 20 robotic and 24 open stage IB1 cases with LVSI reported in the original pathology were re-reviewed by a blinded pathologist for analysis of tissue artifacts and LVSI.ResultsTwo-hundred-thirty-six cases (185 open, 51 robotic) with stages IA2, IB1 and IB2 cervical cancer were reviewed. No significant differences in histology (squamous cell carcinoma, 65% vs. 51%; p = 0.1), IB1 lesion size (≤ 2 cm, 62% vs. 61%, p > 0.1), LVSI (34% vs. 39%, p > 0.1), and depth of stromal invasion (p > 0.1) was found between open and robotic groups. Histologic examination of all IB1 cervical carcinomas revealed a higher degree of surface disruption [45% (9/20) vs. 12.6% (3/24), p = 0.038] and artifactual “parametrial carryover” [65% (13/20) vs. 29% (7/24), p = 0.037] in robotic vs. open groups, respectively, but no significant differences in the rate of LVSI.ConclusionRARH cases that utilized a uterine manipulator did not show any clinico-pathological differences in depth of invasion, LVSI, or parametrial involvement compared to open cases.

► Pathology examination of cases utilizing uterine manipulators revealed increased surface disruption and parametrial carryover, but no change in LVSI.
► Uterine manipulators can be used in robotic-assisted laparoscopic radical hysterectomies without fear of altering pathology or creating false LVSI.
► Risk recurrence scores and treatment recommendations will not be falsely increased in cases where a uterine manipulator is utilized.