Laparoscopic Neocervix Creation in a Woman with Secondary Infertility Following a Radical Trachelectomy for Adenocarcinoma of the Cervix

Abstract

<h3>Study Objective</h3> Cervical cancer continues to affect young woman of childbearing age even though its incidence is on the decline in Australia. [1] Laparoscopic-assisted vaginal radical trachelectomy and pelvic lymphadenectomy for patients with FIGO stage IA1 with lymphovascular space invasion, stage IA2, and stage IB1 cervical cancer is considered to be an appropriate and fertility-sparring alternative to a radical hysterectomy [2]. Unfortunately, cervical stenosis and agenesis/shortening is a known complication of this procedure causing reduced fertility in these women [3]. We present a case of a 32-year-old woman with secondary infertility due to a radical trachealectomy for stage 1 cervical adenocarcinoma. Her cervical agenesis was treated via a laparoscopic-assisted vaginal neocervix creation. <h3>Design</h3> Case Study. <h3>Setting</h3> Theater. <h3>Patients or Participants</h3> A 32-year-old female presented to our infertility clinic with a background of laparoscopic-assisted vaginal trachelectomy, pelvic lymphadenectomy and concomitant cerclage 6 years prior for stage 1 cervical adenocarcinoma. She remained amenorrhoeic post-surgery, but she was ovulatory based on serology and with follicles noted on ultrasound. A HyCoSy failed due to inability to locate and cannulate the cervix. We offered a hysteroscopic dilatation of the cervical canal with laparoscopic assistance and stitch removal as a means to re-canalize the cervix. The surgery is outlined as be our video submission. <h3>Interventions</h3> Laparoscopically-assited vaginal neocervix creation. <h3>Measurements and Main Results</h3> Patent cervix 5 days post-operatively. <h3>Conclusion</h3> We present a novel and minimally invasive technique for a woman with secondary infertility due to cervical agenesis. This may have the potential improve the fertility of women who face cervical stenosis post radical trachelectomy. Advances in oncological surgery and fertility will potentially help solve the question of fertility preservation in women treated for cervical cancer.