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Therapeutic management of early-stage cervical cancer is mainly based on surgery.
Radical trachelectomy is a strategy to preserve the fertility of young patients with cervical cancer.
In the European Society of Gynaecological Oncology (ESGO) 20181 and National Comprehensive Cancer Network (NCCN) Guidelines,2 radical trachelectomy type B is indicated for patients with cervical cancer stage 1B1.
The prospective ConCerv study3 shows the safety of simple conization in early-stage cervical cancer, <2 cm in cases of stromal invasion <10 mm and no lymph vascular space invasion.
The indication for radical trachelectomy remains:
Cervical cancer <2 cm;
Negative lymph node;
Positive lymph vascular space invasion.
The oncological safety of the minimally invasive approach has recently questioned by the international randomized Laparoscopic Approach to Cervical Cancer (LACC trial)4 and several retrospective studies.
These results have therefore renewed interest in the vaginal approach, associated with lymph node staging by laparoscopy.
In this video-article, we describe the indication and the step-by-step technique of radical trachelectomy by the combined laparoscopic vaginal approach. Instruments are described in Online Supplemental File 1.
This technique is a safe oncological procedure in the post-LACC4 era.
Data availability statement
There are no data in this work.
Patient consent for publication
This study involves human participants and was approved by the ethics committee: cantonal committee CER-VD project ID: 2019-01574. Participants gave informed consent to participate in the study before taking part.
Collaborators SENTICOL Group.
Contributors BG made the video, PM supervised and performed the surgery, BG wrote the manuscript, VB FRL, AF and JMA corrected and approved the video article. BG is the author responsible for the overall content as the guarantor.
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.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.