Surgical procedure
METASTASIS, STERILE, CAVITY, STAGGERED, VAGINA, PERITONEAL DISSEMINATION
Following the induction of general anesthesia, the patient was placed in the lithotomy position, then disinfected and draped before access into the abdominal cavity was obtained.The laparoscopic group had four surgical incisions on the patient’s abdominal wall: (1) a 10-mm camera port in the umbilicus, (2) a 5-mm port at the McBurney’s point on the right side, (3) an identical 12-mm working port on the left lateral lower quadrant, and (4) a 5-mm port parallel to the left mid-clavicular line 2 cm laterally at the level of the umbilicus. Abdominal pressure was set to 12 mmHg. The patients were adjusted to approximately 30° of Trendelenburg position. After entering the abdominal cavity, we carefully explored the pelvic and abdominal cavities to rule out peritoneal dissemination or distant metastasis. We adopted the no-lifting technique described in earlier investigations [Subsequently, pelvic lymphadenectomy was performed, and para-aortic lymph node dissection was performed where necessary. Pelvic lymph nodes were resected en bloc according to the order of common iliac → external iliac → deep inguinal → obturator → internal iliac vessels. After dissecting one side of the lymph nodes, it was bagged and sealed in time. The wound was repeatedly rinsed with sterile water for injection, and the contralateral lymph nodes were treated similarly.Following the radical hysterectomy, the Ethicon Johnson & Johnson Echelon Flex Powered Plus Long Articulating Endoscopic Linear Cutter (Endocutter) with two rows of triple staggered titanium staples were inserted through the 12 mm trocar port. The angle between the jaws of the endocutter and the vagina’s longitudinal axis was adjusted to 90°, and then about 3 cm of the upper part of the vagina was closed after ensuring there was no abnormal tissue in the jaws except for the vaginal tissue. After the endocutter is fired, the device’s staples are released, and the vaginal stumps are sewn together on both sides while simultaneously cutting the vaginal wall (Fig. In the ORH group, the patient was placed in the lithotomy position following induction of general anesthesia. A mid-line incision of 20 cm was made on the lower abdomen, and the rest of the procedure was carried out as stated in a previous detailed report [