Introduction The treatment of cervical squamous cell carcinoma, FIGO stage Ia, with no lymphovascular invasion is total hysterectomy with salpingectomy with/without oophorectomy, when there is no intention for fertility-sparing. Lymphadenectomy is usually omitted in those cases. Recently, Ramirez et al evidenced that minimally invasive radical hysterectomy was associated with lower rates of disease-free survival and overall survival than open abdominal radical hysterectomy among women with early-stage cervical cancer. After that work, the uterine manipulator was pointed as an important cause for these results by some authors and many of them proposed closing the vaginal cuff as the first step of the minimally invasive surgery. However, for patients with the Ia1 stage, there is no need for extensive vaginal margin. Moreover, performing laparoscopic hysterectomy without a uterine manipulator is challenging. In this context, vNOTES provides an easy solution.
Description We performed a cervical cerclage invaginating the external cervix orifice followed by conventional vNOTES hysterectomy with bilateral salpingectomy. The patient was positioned in stirrups in Trendelenburg position and standard sterilization was performed. After cervical cerclage, a circular incision was made around the uterine cervix and the following structures were sealed and divided by an advanced bipolar device: uterosacral ligaments, anterior bladder pillars, parametria. Then, a self-constructed vaginal port with alexis® and surgical glove was inserted through the vagina. Pneumoperitoneum was inflated and the sealing/division of uterine arteries, round ligaments, ovarian ligaments, and broad ligaments were completed.
Conclusion vNOTES may provide a safe minimally invasive hysterectomy for Ia1 cervical carcinoma.
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