Introduction/Background Radical trachelectomy is a valuable fertility-sparing treatment option for women with early-stage cervical cancer. Vaginal radical trachelectomy with laparoscopic lymphadenectomy (LVRT) has several limitations (nulliparous patients, previous conization with adverse vaginal anatomy). According to recent studies, 252 patients experienced a total laparoscopic radical trachelectomy (LRT) and there are very few publications about the surgical procedure. In this video, we describe the technique of LRT.
Methodology A nulliparous 33 years-old woman was diagnosed with a stage IB2 endocervical adenocarcinoma (22 mm). To preserve her fertility, we performed a LRT with uterine arteries preservation associated with a laparoscopic cerclage of the uterine isthmus. The pelvic sentinel lymph node biopsy was negative which leaded to bilateral pelvic lymphadenectomy. We opened the para vesical fossa and started the ureteric dissection down to the ureterovesical junction and the dissection of the vesicouterin space. Then, we opened the pararectal fossa and performed a posterior dissection with section of the uterosacral ligaments approximately 20 mm from the uterine insertion and we isolated the ascending branch of the uterine artery. We sectioned the uterine veins. We removed the parametria separately. Trachelectomy was performed after section of the uterine isthmus just below the ascending branches of the uterine arteries and a circumferential colpotomy. Finally, we realized a laparoscopic isthmus cerclage and the uterine isthmus was sutured to the vagina with 2 overlocks, using V-lock thread.
Results The surgery was performed successfully without per-operative complications and lasted 270 minutes. The intra-operative blood loss was <100 mL. The patient was discharge on day 6 with self-catheterization for urinary retention. The were no early post-operative complications. The resection margins were safe, without lymphovascular space invasion and the parametria were free of disease.
Conclusion LRT performed by trained surgeon is a feasible option for young women with early-stage cervical cancer who wants to spare their fertility.
Disclosure Nothing to disclose.
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