Laparoscopic Hysterectomy Following Robotic Radical Trachelectomy

Abstract

<h3>Study Objective</h3> To demonstrate safe laparoscopic technique in performing hysterectomy following a previous radical trachelectomy. <h3>Design</h3> Stepwise demonstration using narrated video footage. <h3>Setting</h3> An academic safety net county hospital. <h3>Patients or Participants</h3> A 38-yo G5P0050 with a history of Stage 1B1 squamous cell carcinoma of the cervix was treated with robotic radical trachelectomy in 2011. She represented ten years later with abnormal uterine bleeding from a large prolapsing fibroid requiring multiple blood transfusions. Patient desires to proceed with definitive surgical management and underwent laparoscopic hysterectomy, bilateral salpingectomy, and cystoscopy. <h3>Interventions</h3> In certain cases of cervical cancer, patients can be offered fertility sparing options such as trachelectomy. Following radical dissection of the parametria, pelvic anatomy becomes distorted due to the development of fibrotic tissue. Additionally, following a trachelectomy a colpotomizer cup cannot be used to help lateralize and protect the ureters from inadvertent injury. Therefore, a completion hysterectomy has an elevated risk of urologic injury. We demonstrate a surgical technique to perform a completion hysterectomy laparoscopically. 1. Ureteral stent placement aids in identification of the ureters in the previously dissected surgical field. 2. Identification of pelvic anatomy and restoring normal anatomy is vital in performing a completion hysterectomy laparoscopically. <h3>Measurements and Main Results</h3> The patient underwent a laparoscopic hysterectomy, bilateral salpingectomy, bilateral ureterolysis, and cystoscopy without intraoperative complications. Her postoperative course was uncomplicated and had no further complaints at her six-week postoperative visit. <h3>Conclusion</h3> This case demonstrates a surgical technique to perform a laparoscopic hysterectomy following a robotic radical trachelectomy.