Article Text

Laparoscopic vaginal radical trachelectomy in the post-LACC era: step-by-step surgical procedure
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  1. Benedetta Guani1,2,3,
  2. V Balaya4,
  3. JM Ayoubi4,
  4. Anis Feki1,3,
  5. Fabrice R Lecuru5 and
  6. Patrice Mathevet2,6
  1. 1Department of Gynecology and Obstetrics, HFR, Fribourg, Switzerland
  2. 2Departement de Gynecologie-obstetrique et Genetique Medicale, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
  3. 3Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
  4. 4Department of Gynecology, Foch Hospital, Suresnes, France
  5. 5Breast, Gynecology and Reconstructive Surgery Unit, Institute Curie, Paris, France
  6. 6Faculty of Biology and Medicine, University of Lausanne, UNIL, Lausanne, Switzerland
  1. Correspondence to Benedetta Guani, Centre Hospitalier Universitaire Vaudois Departement de gynecologie-obstetrique, Lausanne, Switzerland; benedetta.guani{at}hotmail.it

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Therapeutic management of early-stage cervical cancer is mainly based on surgery.

Radical trachelectomy is a strategy to preserve the fertility of young patients with cervical cancer.

In the European Society of Gynaecological Oncology (ESGO) 20181 and National Comprehensive Cancer Network (NCCN) Guidelines,2 radical trachelectomy type B is indicated for patients with cervical cancer stage 1B1.

The prospective ConCerv study3 shows the safety of simple conization in early-stage cervical cancer, <2 cm in cases of stromal invasion <10 mm and no lymph vascular space invasion.

The indication for radical trachelectomy remains:

  • Cervical cancer <2 cm;

  • Negative lymph node;

  • Positive lymph vascular space invasion.

The oncological safety of the minimally invasive approach has recently questioned by the international randomized Laparoscopic Approach to Cervical Cancer (LACC trial)4 and several retrospective studies.

These results have therefore renewed interest in the vaginal approach, associated with lymph node staging by laparoscopy.

In this video-article, we describe the indication and the step-by-step technique of radical trachelectomy by the combined laparoscopic vaginal approach. Instruments are described in Online Supplemental File 1.

This technique is a safe oncological procedure in the post-LACC4 era.

Supplemental material

Figure 1

: Radical trachelectomy specimen

Video 1 In this video we describe the radical trachelectomy by the laparoscopic vaginal approach in 10 steps: step 1: tracer injection in the four cardinal points of the cervix; step 2: sentinel lymph node biopsy by laparoscopy; step 3: vaginal cuff creation; step 4: ventrolateral space opening: 4a. vesicovaginal space opening; 4b. bilateral paravesical space opening; 4c. bilateral bladder pillar treatment; 4d. bilateral ureter dissection; step 5: Douglas pouch opening; step 6: parametrial bilateral section and bilateral ligation of cervicovaginal vessels; step 7: isthmus section; step 8: Douglas pouch closure; step 9: isthmic cerclage; step 10: vaginal reanastomosis.

Data availability statement

There are no data in this work.

Ethics statements

Patient consent for publication

Ethics approval

This study involves human participants and was approved by the ethics committee: cantonal committee CER-VD project ID: 2019-01574. Participants gave informed consent to participate in the study before taking part.

References

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

Footnotes

  • Twitter @BenedettaGuani

  • Collaborators SENTICOL Group.

  • Contributors BG made the video, PM supervised and performed the surgery, BG wrote the manuscript, VB FRL, AF and JMA corrected and approved the video article. BG is the author responsible for the overall content as the 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; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.