Introduction/Background*In 2018 the results of an early termination of the LACC trial were published, followed by a tremendous amount of retrospective trials, all showing the worst outcomes of patients with cervical cancer who were operated by minimally invasive surgery (MIS). After years of training in laparoscopic radical hysterectomy we had go backwards and start learning the open way once again

Methodology Educational video showing new strategies in patients with cervical cancer after LACC trial

Result(s)*Since we already have the laparoscopic platform for sentinel lymph node (SLN) mapping with Indocyanine green (ICG), we decided we will start by doing our surgeries with MIS. After cervical injection of ICG, we search for bilateral SLN. The radical hysterectomy is prepared through laparoscopy by dissecting the retroperitoneal space, identifying vascular structures and ureter. The procedure is continued by the open way. We Coagulate and section uterine artery and ventral, lateral, and posterior parametrium. For the colpectomy we used bigger vaginal clamps in order to avoid tumour spillage inside the abdominal cavity.

In 2019 al 2020 Dr Kohler and Dr Chiva suggested that closing the vagina over the tumour, is a feasible technique that could avoid tumour spillage and may improve the outcomes in MIS. So, we began our learning curve in vaginal cuff in open surgery. After the laparoscopic SLN mapping, we have a vaginal time, and finally the open surgery.

Conclusion*Prospective randomized trials are needed to prove that MIS is safe for our patients with the adding of surgical changes as the vaginal cuff. Meanwhile we keep doing open surgeries with some advantages such as the laparoscopic SNL mapping and the spaces dissection, decreasing the open operating time, and the possibility of tumour spillage with the vaginal cuff.