Introduction/Background Several high profile studies, particularly Laparoscopic Approach to Cervical Cancer (LACC) trial, have reported MIRH was associated with worse prognosis than its open counterpart for the management of early-stage cervical cancer. Additional studies are needed to better understand the mechanisms explaining the worse survival associated with minimally-invasive surgery. However, it has been postulated that use of a uterine manipulator and an open colpotomy are responsible. We hypothesise that a no touch, no spill approach to MIRH will reverse this finding. This video presentation outlines a novel surgical technique that ensures cervical tumour does not encounter the surgical field during Minimally-Invasive Radical Hysterectomy (MIRH).
Methodology A case of a 38 year old female with FIGO IB1 Squamous Cell Carcinoma of the Cervix. Pre-operative staging MRI revealed a tumour size of 2 cm. A type III, nerve-sparing radical hysterectomy, bilateral salpingoophorectomy and pelvic node dissection (PND) was performed. A minimally-invasive approach was employed with assistance of a suprapubic Alexis GelPort© (Applied Medical). No uterine manipulator was used. An Endoloop© (Ethicon) suture to the adnexae aided manipulation. Routine PND was completed bilaterally. Routine ureteric tunnel dissection and bladder reflection was performed. Development of the recto-vaginal space and vaginal cuff was completed with hand-assistance. Infundibulopelvic and uterosacral ligaments were transected as standard. The GelPort was opened to allow cross-clamping of the vagina and excision of the specimen. Vaginal vault and all port sites were closed as standard.
Results The use of the Alexis GelPort© system allowed hand-assisted uterine manipulation, vaginal cuff development and an enclosed colpotomy technique.
Conclusion This novel approach to MIRH reduces the risk of intra-operative tumour spillage. Further refinement of the technique is in progress. However, further investigation of oncologic outcomes in larger prospective studies would be necessary to confirm our hypothesis.
Disclosure Nothing to disclose
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