Introduction/Background Radical trachelectomy (RT) is a viable alternative in selected women who wish to preserve fertility with comparable oncological outcomes to radical hysterectomy. Laparoscopic/robotic routes are associated with better outcomes for recovery, aesthetics and blood loss. RT isundertaken for tumours <2 cm. Uterine artery conservation during LRT is associated with best fertility outcomes.

Methodology We report a case of LRT with uterine artery preservation and bilateral pelvic lymphadenectomy performed at Guy’s & St Thomas’ Cancer Centre in United Kingdom. This video illustrates this technique in a nulligravida woman who was 33 years old and keen to preserve fertility. She had an abnormal cervical smear followed by a large loop excision of transformation zone (LLETZ) for CIN 3. Histology of LLETZ diagnosed G3 endocervical adenocarcinoma FIGO stage IA2 completely excised (tumor size 3.3 mm width and 3.5 mm depth with an extra focus of 1 mm). There was no lympho-vascular space invasion (LVSI). There was associated CIN-2 and high grade CGIN. Pre-operative MRI pelvis and CT chest & abdomen did not identify any metastases.

Results The histology specimen included a cervix with vaginal cuff and attached parametrial tissue and measured 55x50x25 mm. There was no residual cancer in the specimen or lymph nodes. The pelvic lymph node count was 18. The catheter was removed in 48 hrs and bladder assessed by measuring post-void residual volume. The patient was discharged on second day after surgery without complications. She continues to be under surveillance with a disease free interval of 21 months and has not yet tried to conceive.

Conclusion LRT and LND with uterine artery preservation is feasible in young women who desire future fertility. It is a safe option for early cervical cancer with <2 mm size. Advantages with minimally invasive procedures, include enhanced visualization, precise dissection, less blood loss, fewer complications, and shorter hospital stay.