A Case of Robotic Radical Parametrectomy for the Treatment Uterine Cervical Cancer Discovered after Simple Hysterectomy.

Abstract

Study Objective Radical parametrectomy (RP) is one of effective treatment option for patients with invasive cervical cancer incidentally diagnosed after simple hysterectomy. To demonstrate the technique of robotic RP as a minimally invasive approach. Design A case report Setting Gynecology and Obstetrics department of a general hospital. Patients or Participants N/A Interventions A 50-year-old woman, G1P1with previous cesarean section, underwent robotic simple hysterectomy and bilateral salpingo-oophorectomy for the treatment of adenomyosis. Cervical cytology before surgery was negative (NILM). The final pathological examination showed stage 1B1 cervical cancer, 19mm-basaloid carcinoma with LVSI (lymph vascular space invasion) and positive surgical margin. Basaloid carcinoma of the uterine cervix is a more aggressive tumor than SCC. Robotic RP with an upper vaginectomy and pelvic lymphadenectomy was performed as an adjuvant treatment. The operative time was 343min, the estimated blood loss was 400ml, and the number of pelvic lymph nodes removed was 65. Right ureteral adventitia injury was suspected during surgery because of severe pelvic adhesion related with previous surgery, so we successfully repaired it with ureteroneocystostomy and there were no postoperative complications. 1mm-pathological residual disease of basaloid carcinoma in the resected tissue was found (pTb1N0M0). She received adjuvant chemotherapy and no recurrence has been observed. Measurements and Main Results Results to be presented Conclusion The indications for RP have been unclear as the surgical procedure is difficult and may possibly increase the complication rate. Robotic surgery may make RP a more feasible optiondepending on the individual case.