Tubal Coagulation, Z-suturing of External Cervical Os, and Vaginal Washing May Prevent Cancer-cell Spillage during Minimally Invasive Surgery for Endometrial Cancer

Abstract Objectives: The aim of the study was to investigate whether routine tubal ligation, vaginal washing, and Z-suturing of the external cervical os immediately before colpotomy prevents malignant peritoneal contamination during minimally invasive surgery (MIS) for endometrial cancer. Materials and Methods: For this single-center, retrospective study, we included patients aged >20 years who underwent laparoscopy or laparotomy at our institution for preoperatively diagnosed endometrial cancer from December 2019 to November 2023. Patients were categorized into either the laparoscopy or the laparotomy group. Results: A total of 115 patients were evaluated using pre- and posthysterectomy peritoneal cytology. Laparoscopic surgery was performed for patients with early-stage cancer; they had significantly smaller tumors (mean ± standard deviation: 3.0 ± 1.6 vs. 4.3 ± 2.4 cm; P < 0.001) and lower incidence of lymphovascular invasion (16/82 19.5% vs. 17/33 51.5%; P < 0.001) and positive lymph nodes (4/82 4.9% vs. 8/33 24.2%; P = 0.002) compared with those undergoing laparotomy. No significant differences were observed in the occurrence of positive initial cytology, peritoneal cytological contamination, or positive vaginal cytology between the groups. Positive vaginal cytology was significantly associated with the use of a uterine manipulator in the laparoscopy group (25/30 83.3% vs. 26/52 50.0%; P = 0.004). Conclusion: Routine tubal ligation at surgery initiation, Z-suturing, and vaginal washing may reduce the risk of peritoneal cytological contamination during MIS for endometrial cancer. These measures should especially be considered when a uterine manipulator is used.