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Surgical steps of laparoscopic-assisted simple vaginal trachelectomy
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  1. Andrea Plaikner1,
  2. Kathrin Siegler1 and
  3. Christhardt Köhler1,2,3
  1. 1 Department of Special Operative and Oncologic Gynecology, Asklepios Clinic Altona, Hamburg, Germany
  2. 2 Department of Gynecology, German Red Cross Clinic Berlin Westend, Berlin, Germany
  3. 3 Institute for Dysplasia and Cytology, MVZ Fürstenbergkarree Berlin, Berlin, Germany
  1. Correspondence to Dr Andrea Plaikner, Department of Special Operative and Oncologic Gynecology, Asklepios Clinic Altona, Hamburg, Hamburg, Germany; an.plaikner{at}gmail.com

https://doi.org/10.1136/ijgc-2023-004643

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    In contrast to other gynecologic malignancies, cervical cancer often affects young women still seeeking motherhood. Radical trachelectomy, developed at the end of the last century, is currently considered to be the most appropriate oncological procedure in patients who want to maintain their uterus. In strict accordance with internationally accepted indications and limitations, radical vaginal trachelectomy as fertility-sparing surgery is as safe as radical hysterectomy for women diagnosed with early cervical cancer.1

    Tailored cervical surgery such as conization (or re-conization) and simple trachelectomy are more frequently proclaimed as a surgical option for women with low-risk disease, due to their oncologic adequacy and better obstetric outcome compared with radical trachelectomy. The key steps of simple trachelectomy are more extended cervical and vaginal resection compared with conization without parametrial resection. In the illustrated case, a laparoscopic-assisted vaginal simple trachelectomy was performed, whereby prior to the vaginal portion of the procedure, a laparoscopic dissection of the vesicovaginal and rectovaginal space were performed.

    Video 1 Step by step surgical procedure of laparoscopic-assisted simple vaginal trachelectomy

    However, only limited data exist from small cohorts of simple trachelectomy and comprise fewer than 300 published patients. Moreover, inclusion criteria for simple trachelectomy vary considerably between studies, and multifocal International Federation of Gynecology and Obstetrics (FIGO) stage IA1, stage IA1 L1, stage IA2, and stage IB1 tumors are included.2

    The incidence of parametrial spread in tumors less than 2 cm with negative lymph nodes and no lymphovascular space invasion (LVSI) is low, and given the fact that in most radical vaginal trachelectomy specimens no residual tumor is found, a clear tendency towards tailoring radicality in cervical resection is observed worldwide.3

    Figure 1
    Figure 1

    Final situs after completing the vaginal portion of the simple trachelectomy. The neocervix is readapted to the vaginal skin, and the cervical stent is placed in the cervical canal.

    Ethics statements

    Patient consent for publication

    Ethics approval

    Ethikkommision der Hamburger Ärztekammer; 2020-10107-BO-ff (October 30, 2020).

    References

    1. ↵
      2. Plante M ,
      3. Renaud M-C ,
      4. Sebastianelli A , et al
      . Simple vaginal trachelectomy in women with early-stage low-risk cervical cancer who wish to preserve fertility: the new standard of care?. Int J Gynecol Cancer 2020;30:981–6. doi:10.1136/ijgc-2020-001432
      OpenUrlAbstract/FREE Full Text
    2. ↵
      2. Morice P ,
      3. Maulard A ,
      4. Scherier S , et al
      . Oncologic results of fertility sparing surgery of cervical cancer: an updated systematic review. Gynecol Oncol 2022;165:169–83. doi:10.1016/j.ygyno.2022.01.023
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    3. ↵
      2. Schmeler KM ,
      3. Pareja R ,
      4. Lopez Blanco A , et al
      . ConCerv: a prospective trial of conservative surgery for low-risk early-stage cervical cancer. Int J Gynecol Cancer 2021;31:1317–25. doi:10.1136/ijgc-2021-002921
      OpenUrlAbstract/FREE Full Text

    Footnotes

    • Contributors All authors contributed to the development of the educational video clip and the literature research. AP is acting as 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; internally peer reviewed.