Introduction Because of the concern of the tumor exposure during the classical LRH procedure for cervical cancer,we designed and implemented a surgical approach that ensure no tumor exposure throughout the procedure.

Description 1. The first step of the surgery is determing the lower border of the anterior and posterior vaginal walls which are intended to be excised.Then suture them together to seal the cervical cancer, so as to ensure no tumor exposure throughout LRH surgery. 2. 40 ml saline is injected into the vesicovaginal and rectovaginal spaces respectively to facilitate separation of the anterior and posterior spaces. 3. The anterior and posterior vaginal walls are cut to expose vesicovaginal space and rectovaginal space by monopolar electrocautery. Fingers are used to further separate the anterior and posterior spaces to reach the anterior and posterior reflection peritoneum. 4. A gauze is plugged into the two spaces respectively for support and as a marker. 5. after completing the pelvic lymphadenectomy,the operator cut the uterorectal and uterovesical reflection peritoneum to expose the gauze in above two spaces that have already been separated transvaginally . 6. After above procedures,the dissection of ureteral tunnel,and the cut of cardinal ligament,sacral ligament,and paravaginal tissues become simple.Finally,the LRH surgery is completed easily and safely,and no tumor exposure throughout the surgery.

Conclusion/Implications This surgical method can not only ensure no tumor exposure in the whole course of LRH surgery on cervical cancer,but also make the LRH surgery simple and safe.