Aiming for Recurrence-Free MI-RH/RT for Early Invasive Cervical Cancer - Focusing on Complete Resection and No-Touch Isolation Techniques 1

Abstract

Video Objective To demonstrate techniques to regulate and improve the safety and completeness of laparoscopic and robotic radical hysterectomy/radical trachelectomy (L-RH/RT+R-RH/RT=MI-RH/RT) for early invasive cervical cancer. We will present our techniques and skills as well as data on our long-term outcomes for MI-RH/RT patients. Setting Urban general hospital in Japan. Interventions 170 early invasive cervical carcinoma stage IA1(LSVI+)-IB1 who underwent MI-RH/RT between 2006-2015 were reviewed. Cases who underwent neo-adjuvant therapy were excluded from this study. In laparoscopy, knowledge laparoscopic anatomy and how to dissect are the most important points for reaching the goals of the surgery. Setting landmarks for dissection boundaries ensures completeness of dissection. For our type C radical hysterectomy/ trachelectomy, our goal is to remove the full length of the cardinal ligament. This is to prevent recurrence. To prevent the scattering of tumor cells, we create a vaginal cuff as an initial stage of our procedure and don't use a uterine manipulator as there is the concern that this could stimulate any tumors in the vicinity. When extracting the specimen, we use a large protection bag. This bag prevents spillage of tumor cells in the abdominal cavity and prevents possible port site/ extraction site contamination. Of the patients included in this study, disease-free survival is 97.1% and the 5 year overall survival in 98.2%. Conclusion In our retrospective study, minimally invasive approach for early-stage non-bulky cervical cancer is feasible and safe in terms of oncological outcomes.