Artefactual Changes in Robot-Assisted and Laparoscopic Hysterectomies
A Krizova, BA Clarke, M Bernardini, S James, S Boerner, AM Mulligan. University of Toronto, Toronto, Canada; University Health Network (UHN), Toronto, Canada; UHN, Toronto, Canada; St. Micheal's Hospital, Toronto, Canada
Background: Total laparoscopic hysterectomy is a minimally invasive technique resulting in reduced morbidity and better cosmesis. The literature is discrepant as to whether it results in a higher incidence of positive peritoneal cytology and associated artefactual changes, including vascular pseudoinvasion (VPI), have been described.
Design: We conducted a retrospective histopathologic review of 191 hysterectomy specimens (79 malignant, 112 benign) from two centers, blinded to the surgical technique. The hysterectomy types included total abdominal (63), vaginal (18),laparoscopic with intrauterine manipulator (IM) (47),laparoscopic without IM (6) and robot-assisted laparoscopic (43). We documented the following features: endometrial disruption (ED), nuclear crush, VPI, endomyometrial cleft artefact with or without epithelial displacement, inflammatory debris in clefts and vascular spaces and debris (inflammatory or tumor fragments) in fallopian tube (FT) lumen. Comparisons of findings between procedures using IM and those without IM were performed using χ2 or Fisher exact test with a significance of P<0.05. Subgroup analysis was performed based on benign or malignant endometrial disease.
Results: Artefactual changes of ED, nuclear crush, cleft formation, inflammatory debris within intravascular, artefactual spaces and FT lumen and VPI were significantly more associated with the use of IM, independent of whether the endometrial pathology was benign or malignant. Use of IM also resulted in significantly more detached tissue fragments in the endocervix. There was no significant difference in peritoneal washing cytology between the two groups. In two cases, misinterpretation of artefactual changes resulted in patients being incorrectly staged.
|Intrauterine Manipulator (%)||No Intrauterine Manipulator (%)|
|Debris in spaces/vessels||34||5|
|Debris in FT lumen||33||4|