Optimizing outcomes in minimally invasive radical hysterectomy: the protective role of a vaginal pipe.

Authors

Seongmin Kim, Hyunkyoung Seo, Seon-Mi Lee, Sanghoon Lee, Jae-Yun Song, Jae-Kwan Lee, Nak-Woo Lee

Published in

Journal of gynecologic oncology. Sep 01, 2026. Epub Sep 01, 2026.

Abstract

Following the 2018 LACC trial, minimizing intraoperative tumor spillage during minimally invasive radical hysterectomy (MIRH) became critical in early-stage cervical cancer. This study investigated whether a vaginal pipe reduces tumor spillage and recurrence during MIRH.
We retrospectively reviewed International Federation of Gynecology and Obstetrics 2018 stage IA1-IIA2 cervical cancer patients undergoing radical hysterectomy (2014-2022). Of 216 patients, 35 underwent abdominal radical hysterectomy and 181 underwent MIRH, subdivided by vaginal pipe usage: vaginal pipe group (MIRH-Y, n=77) and non-use group (MIRH-N, n=104).
Baseline characteristics differed only in age (p=0.004) and tumor size (p=0.003). No significant differences were found in 2-year disease-free survival (DFS, p=0.578) or 5-year overall survival (p=0.532). Recurrence occurred in 3 (3.9%) patients in MIRH-Y vs. 12 (11.5%) in MIRH-N. In multivariate Cox regression adjusting for age and tumor size, vaginal pipe use showed a marginal trend toward reduced recurrence (adjusted hazard ratio [HR]=0.31; 95% confidence interval [CI]=0.09-1.09; p=0.068), consistent with inverse probability of treatment weighting (IPTW) analysis (HR=0.36; 95% CI=0.13-1.04; p=0.058). Patients with tumors ≤2 cm showed favorable DFS in the MIRH-Y group (p=0.037), whereas no differences were observed in tumors >2 cm.
In this exploratory analysis, vaginal pipe use during MIRH was associated with a non-significant trend toward lower recurrence, with a statistically significant DFS difference only in tumors ≤2 cm. Because these associations did not reach statistical significance, these hypothesis-generating findings warrant prospective confirmation before the device can be recommended as a routine surgical adjunct.

PMID:
42800703
Bibliographic data and abstract were imported from PubMed on 27 Sep 2026.

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