Introduction Minimally invasive surgery decreases postoperative morbidity after radical hysterectomy (RH) for early-stage cervical cancer. However, studies reported lower survival and higher recurrence rates as compared to open surgery, which maybe due to tumour spillage into the abdominal cavity during vaginal colpotomy or use of a uterine manipulator. This surgical film aims to present a methodical step-by-step approach for robotic radical hysterectomy with added steps for preventing tumour spillage.
Description A 48-year-old multiparous lady underwent loop electrosurgical excision procedure (LEEP) for CIN III (Cervical Intraepithelial Neoplasia) which was reported as well differentiated squamous cell carcinoma. There was no visible lesion on clinical examination or imaging. Here is an account of the steps of surgery- Creation of retroperitoneal spaces Ureterolysis Transection of right uterine artery Transection of right infundibulopelvic and round ligaments Bladder mobilization Similar steps on opposite side Development of Rectovaginal space Dissection of ureters in ureteric tunnel Parametrectomy Vaginal cuff sealed using Endoscopic stapler Sealed distal edge opened and specimen delivered vaginally Pelvic lymph node dissection Vault closure Operative time was 180 minutes and blood loss was 50 ml. Post-operative course was uneventful and patient was discharged after three days.
Conclusion/Implications Robotic assisted radical surgery is a safe and precise technique in the treatment of cervical cancer, with clear definition of anatomical spaces. Vaginal closure using endoscopic stapler to seal the vagina before colpotomy is an effective and feasible way to prevent dissemination of tumor cells intra-peritoneally and can improve oncological outcomes like rates of recurrence and survival.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.