Objective Radical trachelectomy combined with pelvic lymphadenectomy has been used to treat early stage cervical cancer patients who wish to preserve their fertility. Although vaginal, abdominal, laparoscopic, and robotic approaches have been used during this procedure, all of these approaches cause peritoneal damage, which could result in periadnexal adhesion. The aim of the present study was to introduce and discuss a novel fertility-preserving option, extraperitoneal radical trachelectomy with pelvic lymphadenectomy.

Methods To minimize peritoneal damage, we developed a new surgical approach for radical trachelectomy combined with pelvic lymphadenectomy. All surgical procedures associated with radical trachelectomy and pelvic lymphadenectomy were performed via an extraperitoneal approach. During this procedure, the uterine arteries, inferior hypogastric nerve, and pelvic splanchnic nerve were preserved.

Results Extraperitoneal nerve-sparing radical trachelectomy with pelvic lymphadenectomy was performed in 3 Japanese women with International Federation of Gynecology and Obstetrics stage IA2 and IB1 cervical cancers. In all patients, complete resection of the disease was achieved without causing any intraoperative complications. Although an infected lymphocele developed in a patient that was managed conservatively, no severe postoperative complications were noted. No adjuvant treatments were given, and the patients are currently free of disease.

Conclusions To the best of our knowledge, this is the first report about extraperitoneal radical trachelectomy in patients with early stage cervical cancer. Extraperitoneal radical trachelectomy combined with pelvic lymphadenectomy can be safely performed. Because peritoneal damages, which can cause periadnexal adhesion, could be avoided, we consider that this surgical approach may be an ideal treatment option for women with early stage cervical cancer who wish to preserve their fertility.