Introduction/Background The patient was diagnosed with squamous cell carcinoma of the cervix, with a detected diameter of 3 cm. No lymphovascular space involvement was present. A contrast-enhanced pelvic MRI with diffusion-weighted analysis and PET CT was performed, and no local or distant metastasis was detected.

Methodology

1. The retroperitoneum was opened, and the peritoneum was opened at the pararectal space. Rectovaginal rectouterine ligaments were identified, along with the ligamentous mesometrium at their insertion into perirectal tissue.

2. Identification of the ureter was performed. The mesoureter is located at the base of the ureter and is attached to the mesorectum. The avascular space between the ligamentous mesometrium and pararectal space was followed, and the mesoureter was lateralized. Medial and lateral pararectal spaces are demonstrated. Paracervical tissue belonging to ligamentous mesometrium was cut from the lateral pelvic sidewall and endopelvic fascia.

3. The vesicouterine fold was opened following the demarcation line between mesonephric and Mullerian structures, with the latter showing more yellow. The round ligaments were cut at the entrance to the inguinal channel.

4. Vascular mesometrium was managed first following avascular spaces. The bladder mesentery containing the superior vesical artery was determined. The avascular space between the ureter and vaginal wall was reached. The deep uterine vein was detected and resected. The ureteric vascular supply of mesometrium was divided. The mesonephric blood supply was preserved. Mesocolpium was resected; the vaginal incision was made when the necessary vaginal length was achieved.

Results The urinary catheter was removed on the 3rd postoperative day. No post-urinary residual was present. The patient was discharged on the 5th day of surgery without any complications. The final stage was FIGO IB2 without any lymphovascular involvement. The patient received no adjuvant therapy.

Conclusion This surgical video aims to demonstrate the surgical technique for total mesometrial resection.

Disclosures Total mesometrial resection, first defined by Hockel, is a surgical technique for cervical cancer based on embryological development. The tissues originate from paramesonephric-mesonephric and Mullerian tubercles.