Transumbilical laparoendoscopic single-site radical trachelectomy with uterine arteries’ ascending branches preservation for early-stage cervical cancer

Cervical cancer is the fourthleading cause of cancer incidence and death among females according to Global Cancer Statistics 2018. With an increasing number of young women being diagnosed with cervical cancer, fertilitysparing surgery is widely demanded. According to 2022 National Comprehensive Cancer Network guidelines, radical trachelectomy and pelvic lymphadenectomy are indicated for patiens with stage IA2, stage IB1, and selected stage IB2 cervical cancers, meaning minimally invasive approach remains an option. The transumbilical laparoendoscopic singlesite (TULESS) approach is now gaining in popularity for treating gynecologic diseases because of its convenient specimen extraction, better cosmesis, reduced postoperative pain, and shorter recovery period. To the best of our knowledge, this is the first case in which the whole laparoscopic procedure of radical trachelectomy through TULESS approach has been reported. This video demonstrates the fertilitysparing surgery procedure containing radical trachelectomy and pelvic lymphadenectomy with bilateral ascending branches of uterine arteries preservation. The patient was a 34yearold woman diagnosed with International Federation of Gynecology and Obstetrics stage IB1 moderately differentiated squamous cervical


GYNECOLOGICAL CANCER
Cervical cancer is the fourth-leading cause of cancer incidence and death among females according to Global Cancer Statistics 2018. 1 With an increasing number of young women being diagnosed with cervical cancer, fertility-sparing surgery is widely demanded. According to 2022 National Comprehensive Cancer Network guidelines, radical trachelectomy and pelvic lymphadenectomy are indicated for patiens with stage IA2, stage IB1, and selected stage IB2 cervical cancers, meaning minimally invasive approach remains an option. The transumbilical laparoendoscopic single-site (TU-LESS) approach is now gaining in popularity for treating gynecologic diseases because of its convenient specimen extraction, better cosmesis, reduced post-operative pain, and shorter recovery period. 2 To the best of our knowledge, this is the first case in which the whole laparoscopic procedure of radical trachelectomy through TU-LESS approach has been reported.
This video demonstrates the fertility-sparing surgery procedure containing radical trachelectomy and pelvic lymphadenectomy with bilateral ascending branches of uterine arteries preservation. The patient was a 34-year-old woman diagnosed with International Federation of Gynecology and Obstetrics stage IB1 moderately differentiated squamous cervical Video 1 TU-LESS radical trachelectomy and pelvic lymphadenectomy with bilateral ascending branches preservation for early-stage cervical cancer.

Video article
cancer who expressed a strong desire for reproduction. After sufficient consultation, she decided to receive a fertility-sparing treatment protocol. This video highlights the feasibility of sufficiently dissecting paracervical structures and exposing uterine artery branches with complex procedures and no assistance via TU-LESS. We adopted a simplified uterine manipulator, which minimized the squeezing and injury to the cervix, to assist exposure of the surgical field. Resection of the cervix was accomplished transvaginally with a cold knife to ensure sufficient margin. Pathology examination of surgical margin, lymph node specimens, and lymphovascular invasion were negative. The umbilical incision was closed by Zheng's anchor suturing technique to prevent incisional complications and improve cosmetics. 3 No disease recurrence or surgical complications were detected in the 6 months of follow-up.
Minimally invasive surgery is safe and effective for fertilitysparing without compromising oncologic outcomes, especially in patients with a tumor size <2 cm. 4 TU-LESS is a feasible option for delicate dissection in radical trachelectomy and can achieve minor incision and faster recovery. However, owing to the limited operational space and absence of assistance in TU-LESS, this type of surgery requires an extensive learning curve before performance.
Contributors YC performed the data collection, video production, and manuscript preparation. YZ was the guarantor of the study and was a responsible surgeon. QW and SD were responsible surgeons. Competing interests None declared.
Patient consent for publication Not applicable.
Ethics approval This study involves human participants and was approved by West China Second University Hospital (protocol identification number: 2022034) Participants gave informed consent to participate in the study before taking part.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article and video.
Open access This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/ licenses/by/4.0/.