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Robotic uterine transposition for a cervical cancer patient with pelvic micrometastases after conization and pelvic lymphadenectomy
  1. Renato Moretti Marques1,
  2. Audrey Tieko Tsunoda2,
  3. Rodrigo Souza Dias3,
  4. Juliana Martins Pimenta4,
  5. José Clemente Linhares2 and
  6. Reitan Ribeiro2
  1. 1 Department of Gynecologic Oncology, Albert Einstein Israelite Hospital, Sao Paulo, Brazil
  2. 2 Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba, Paraná, Brazil
  3. 3 Department of Radiotherapy, Universidade Federal de Sao Paulo Escola Paulista de Medicina, Sao Paulo, Brazil
  4. 4 Departmento of Oncology, Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil
  1. Correspondence to Dr Reitan Ribeiro, Erasto Gaertner Hospital, Curitiba, Paraná, Brazil; reitanribeiro{at}hotmail.com

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Uterine transposition was first reported1 in 2017 as a possible fertility sparing surgery for patients with non-gynecologic cancer who require pelvic radiotherapy. In 2018, it was reported in a patient with cervical cancer.2 The main concept is that the uterus with the adnexas can be mobilized away from the radiotherapy field as a flap, using the gonadal vessels as pedicles. The surgery is evolving.3 The objective of this video 1 is to present the technique using a surgical robotic platform.

Video 1

A 28-year-old woman with International Federation of Gynecology and Obstetrics stage IA1 squamous cell carcinoma of the cervix, with lymph vascular space invasion, was diagnosed following a loop electrosurgical excisional procedure. Laparoscopic sentinel lymph node dissection associated with a new conization was performed, and the pathological analysis showed lymph node micrometastasis in one lymph node, out of two (one on each side of the pelvis), and no residual tumor at the cervix. The patient then had an open bilateral pelvic lymphadenectomy which found no additional metastases in 20 lymph nodes. The patient refused adjuvant radiotherapy because of the risk of infertility. After multidisciplinary board discussion, she was referred to our center for uterine transposition prior to chemoradiation. Double docking robotic surgery was performed to access the pelvis and superior abdomen. The uterine corpus/cervix, and ovaries were detached from the pelvis and robotically sutured to the anterior upper abdominal wall, after extensive gonadal vessel dissection. Previous pelvic dissection makes gonadal vessel dissection risky. Also, the short residual cervix did not allow for umbilical implantation. Ten days after uterine transposition, external radiotherapy (45 Gy) with concurrent cisplatinbased chemotherapy was delivered to the pelvis. After adjuvant treatment, the uterus and ovaries were robotically repositioned and the residual cervix anastomosed to the vagina. After 20 months of follow-up, the patient has normal menses and hormonal function. There is no recurrence and the patient has not attempted to get pregnant.

Robotic uterine transposition represents a potential variation to the laparoscopic approach. However, studies to determine its viability, effectiveness, and safety are needed.

References

Footnotes

  • Contributors RM-M, ATT, JMP, RSD, JCL, and RR provided substantial contributions to the conception or design of the work. All authors participated in drafting the work, revising it critically, and approving the final version. All authors agree to be accountable for all aspects of the work and are able to discuss questions related to the accuracy and integrity of any part of the work. RR was responsible for editing the video and RM-M for the follow-up data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Open data All data relevant to the study are included in the article

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