Complicated Laparoscopic Trachelectomy Following Supracervical Hysterectomy

Abstract

<h3>Study Objective</h3> To review the most common indications and risk factors for trachelectomy after supracervical hysterectomy and demonstrate technique for a complicated laparoscopic trachelectomy. <h3>Design</h3> Narrated video tutorial for a safe and reproducible laparoscopic trachelectomy complicated by extensive adhesive disease after supracervical hysterectomy. <h3>Setting</h3> Although trachelectomy is a relatively uncommon procedure, it may be indicated for a variety of benign pathologies women who have undergone supracervical hysterectomy. The potential complications of this procedure may be elevated from baseline surgical risks due to the presence of adhesive disease from prior surgeries or concurrent pelvic pathologies. This patient underwent her surgery at a tertiary academic center. She was positioned in dorsal lithotomy with arms tucked for surgical ergonomics. <h3>Patients or Participants</h3> This is a 43-year-old para 1 who presented for surgical management of cyclic heavy vaginal bleeding after a supracervical hysterectomy for adenomyosis and fibroids in 2014. <h3>Interventions</h3> This educational video demonstrates a complicated laparoscopic trachelectomy with an opportunistic bilateral salpingectomy, left ureterolysis, excision of endometriosis, and cystoscopy. <h3>Measurements and Main Results</h3> Not applicable. <h3>Conclusion</h3> Laparoscopic trachelectomy after supracervical hysterectomy may be significantly complicated by adhesive disease. The following strategies are key in the approach to a complicated laparoscopic trachelectomy: 1. Restoration of normal pelvic anatomy 2. Retroperitoneal dissection to safely identify the ureters, as well as the gonadal and uterine vessels and 3. Use of a uterine manipulator with a colpotomy ring to delineate target tissues, allow for multidirectional movement and facilitate safe entry into key planes.