Vaginal hysterectomy using the ERBE BiClamp (R) bipolar vessel sealing system as a surgical approach for endometrial cancer-single surgeon experience from a district general hospital

Uterine cancer is the most common gynaecological malignancy with increasing incidence due to rising ageing, increasing obesity within the population and falling rates of hysterectomy for benign disease. European and British guidelines advocate a minimally invasive surgery (MIS) even in patients with high-risk endometrial cancer (EC). The standard surgical procedure is total hysterectomy with bilateral salpingo-oophorectomy. Our study examines vaginal hysterectomy (VH) performed using the ERBE BiClamp (R) bipolar vessel sealing system as a surgical approach for EC following studies demonstrating its safety in VH for benign disease. Retrospective review of a single surgeons practice of patients booked for VH as the surgical treatment of EC (2011-2019). Patients' electronic records and paper charts were reviewed. Primary outcome was oncological safety and secondary outcomes were intra-operative blood loss, complications encountered, and length of hospital stay (LOS). The comparison group where previously studied patients undergoing BiClamp (R) VH by the same surgeon for benign/pre-malignant conditions. A total of 127 patients were included (median age 64 years, median BMI 32 kg/m(2)). Mean Hb drop was 9.3 g/L. 50.4% of patients were discharged on the 1st post-operative day and 82.7% by day 2. A total of 35 patients received adjuvant treatment. There were 2 cases of vault recurrence and 2 patients died from disease progression. Overall, 5 year survival was 92.9% with the majority of deaths dues to cardiac causes or a separate malignancy. The rate of disease progression was 3.1%. This study suggests that BiClamp (R) VH is an oncologically safe procedure and could be considered as an alternative MIS approach in the cohort of patients who are not suitable for laparoscopic or robot-assisted staging surgery. The technique affords a short operative time, minimal bloods loss, short LOS with acceptable surgical outcomes and similar oncologic outcomes to other surgical approaches.