Vascular Pseudoinvasion in Laparoscopic Hysterectomies: Intraoperative Effect or Pathology Grossing Artifact?
Linda Feeley, Anna Marie Mulligan, Sarah James, Adriana Krizova, Blaise Clarke. St Michaels Hospital, Toronto, Canada; UHN, Toronto, Canada; University of Toronto, ON, Canada
Background: We have previously shown that histologic artifacts including vascular pseudo-invasion (VPI) are significantly more common in laparoscopic than non-laparoscopic hysterectomies and specifically in cases in which a uterine manipulator (UM) is used. Whether or not VPI occurs intraoperatively or is a post-operative grossing artifact is unknown. The aim of this study was to assess the influence of grossing techniques in introducing artifacts including VPI in a subset of prospectively accrued laparoscopic hysterectomies (LH) utilizing a UM. The specimens were processed using an alternative approach aimed at reducing mechanical transport at the time of grossing.
Design: The previously recommended alternative grossing technique was used in 16 LH as follows: the uterus was bivalved on receipt to permit overnight fixation. In contrast to the standard approach of sectioning from mucosa to serosal surface, the uterine wall was sectioned from the serosal aspect towards the mucosal surface with care to clean the scalpel blade between sections. The presence of artefactual changes including nuclear crush artifact, endomyometrial clefting, debris (inflammatory or tumor fragments) in fallopian tube (FT) lumen and VPI, were evaluated and compared with those from 57 LH grossed in the standard way using the Fisher exact test. The number of vessels involved by VPI was compared between the groups using the Student t-test.
Results: No significant difference between the groups was identified for any of the artifacts [Table 1].
|Artifact||Standard Grossing Technique, N(%)||Alternative Grossing Technique, N(%)||P-value|
|Serosal carry over||11(20)||5(31)||0.49|