Efficacy and safety of TU-LESS retroperitoneal lymphadenectomy with manipulator-free laparoscopic hysterectomy in endometrial cancer staging

With the rising frequency and earlier onset of endometrial cancer (EC), improved surgical skills have emerged as a priority. The objective of this study was to determine the effectiveness and safety of transumbilical laparoendoscopic single-site surgery (TU-LESS) via the retroperitoneal approach for lymphadenectomy and multi-port laparoscopic surgery (MLS) in high-risk EC patients. This retrospective study included 48 high-risk EC patients from June 2022 to June 2023. Twenty-two patients underwent TU-LESS (experimental group) via a retroperitoneal approach and 26 patients underwent MLS via the transperitoneal approach for lymphadenectomy (control group) with all patients undergoing lymph node dissection. Groups were matched for perioperative outcomes, lymph node harvest, tumor markers, pain scores, cosmetic satisfaction, complication rates, and quality of life 24 months postoperatively. Operative duration, blood loss, number of pelvic lymph nodes harvested, and complication rate were similar between groups (P > 0.05). The experimental group had more para-aortic lymph nodes removed (12.7 ± 4.1 vs. 8.3 ± 3.7), fewer catheterization days (2.1 vs. 3.4 d), fewer days to drainage removal (3.5 vs. 5.0 d), a shorter length of hospital stay (6.2 vs. 8.0 d), a lower postoperative visual analogue scale score (3.2 vs. 4.5), and lower tumor marker levels than the control group (all P < 0.01). Neither group reported intra- or post-operative complications. Cosmetic satisfaction was better in the experimental group than the control group. The 24-month follow-up evaluation demonstrated improved quality of life without recurrence in both groups. TU-LESS is a safe and effective method for high-risk EC with better recovery and cosmetic results, a good quality of life, and no recurrences or complications during 24 months of follow-up care. Due to the small sample size, short period of follow-up, and the confounding factors of study design, the results warrant further validation with additional cases from multiple centers long-term follow-up.