Introduction/Background In recent years fertility sparing treatments are increasingly developing in patients with early-stage cervical cancer. Among these, trachelectomy represents a milestone with wide range of surgical approaches, evidence of oncological safety and positive obstetric outcomes.
This video shows how it is possible to perform a laparoscopic assisted vaginal radical trachelectomy with concomitant cerclage position in a patient who wants to preserve her fertility.
Methodology The case is of a 26-year-old patient who underwent conization for CIN3 with a subsequent diagnosis of squamous cervical cancer stage FIGO IB1. After a negative laparoscopic bilateral pelvic nodes sampling and the radiologic evidence of a disease limited to the cervix the patient was candidate to trachelectomy according to her fertility sparing desire.
Results The vesico-uterine space is dissected and the bladder moved down. A window is made on the broad ligaments and bilateral ureterolysis performed. The recto-vaginal space is then dissected till the medial para-rectal fossa.
Circular colpotomy is vaginally performed with a 1 cm tissue rim and the cervix is closed with Vicryl stitches in a vaginal cuff to avoid tumor spread. Careful dissection of the anterior and posterior septa is then carried out until reunification with laparoscopic dissection. Bilateral parametrectomy is performed 5 mm cranially the uterine artery arches and 1 cm far from the cervix. Radical trachelectomy is finalized with a negative deep margin at the frozen section. The uterine isthmus is then sutured to the vagina.
In the second laparoscopic time a 3 mm monofilament polypropylene sling cerclage is bilaterally positioned from posterior to anterior through the broad ligaments opening and fixed anteriorly on the uterine isthmus to prevent an eventual preterm delivery.
Conclusion Laparoscopic assisted vaginal trachelectomy, is a feasible procedure combining the conservative advantages of the vaginal approach and the oncological safety of laparoscopic spaces dissection with good obstetric outcomes.
Disclosures This work was supported by French state funds managed within the ‘Plan Investissements d’Avenir’ and by the ANR (reference ANR-10-IAHU-02).
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