Laparoscopic Cerclage During Radical Trachelectomy—a Novel Technique: A Case Report and Review of the Literature

Abstract

Background: Cervical cancer is a common gynecologic malignancy in reproductive-age patients. Radical trachelectomy (RT) is a vital treatment for those with early stage cervical cancer who wish to preserve their fertility. While most reports indicate cerclage use during RT, the efficacy of this approach is still debatable, and complications—mainly cerclage erosion and cervical stenosis—of permanent cerclage placement are not unlikely. The literature lacks a detailed description of cerclage placement during RT, and there is no accepted standard for this placement. This report introduces a novel laparoscopic cerclage procedure during minimally invasive RT, providing a detailed description and schematic representation of the technique for which the suture material is imbedded into the cervical stroma. Case: A 33-year-old woman had invasive squamous-cell carcinoma of the cervix. She had loop electrocautery excision and a cone biopsy with endocervical curettage. The pathologic report specified that the carcinoma was at least 8 mm wide and 6 mm deep with lymphovascular-space invasion and that she had cervical-intraepithelial neoplasia grade 3 adjacent to the tumor. Her cancer was at International Federation of Gynecology and Obstetrics stage 1B1. Laparoscopic RT with bilateral lymph-node dissection and cervical cerclage were performed. Results: This patient had an uneventful recovery after the surgery. More than a year later she had no evidence of disease and few complaints. Conclusions: In addition to the standardization of cerclage placement during laparoscopic RT and given that eventually less suture material is exposed to the peritoneal surface, the current authors' cerclage technique has the potential to reduce the risks of cervical stenosis and cerclage erosion through the vaginal fornix. (J GYNECOL SURG 36:136)