Robotic Trachelectomy for Cervical Myoma after Partial Hysterectomy

Abstract

<h3>Study Objective</h3> To present a rare case of cervical leiomyoma in a post partial hysterectomy patient. <h3>Design</h3> Case report illustrated with video. <h3>Setting</h3> Under general anesthesia, the patient was placed in dorsolithotomy position, arms alongside the body and legs 80°abducted in adjustable stirrups. Two robotic portals were positioned in both iliac fossae, in addition to the umbilical, and a conventional laparoscopic portal was placed on the right flank. The cervix was manipulated and delineated with a 60cc syringe. <h3>Patients or Participants</h3> We present a case of a 43-year-old woman who had undergone partial hysterectomy 8 years ago due to intense menstrual bleeding and multiple uterine fibroids. She went to the gynecologist with a complaint of deep dyspareunia and chronic pelvic pain in the left lower quadrant. These complaints started after 3 years of hysterectomy and were now more intense. Physical examination revealed the presence of a partially mobile nodule of 5cm in left iliac fossa, slightly sore to the touch. During the investigation, her pelvic MRI showed signs of partial hysterectomy, the uterine cervix with multiple retention cysts and a well-defined nodule with low T2 signal in the left lateral region vascularized by branches from the left internal iliac vessels measuring 5.3 × 4.2 × 4.7 cm. Cervical cytology was negative. <h3>Interventions</h3> Patient was eligible for a robotic-assisted simple trachelectomy. <h3>Measurements and Main Results</h3> Surgery duration time was 2 hours with minimal blood loss. She was discharged after 15 hours with mild soreness. After 2 weeks she had complete remission of symptoms and the final pathological report confirmed leiomyoma of the uterine cervix. <h3>Conclusion</h3> Partial hysterectomy may not be enough for uterine fibroid treatment once the uterine cervix can be a site of fibroid growth. In addition, surgery afterwards may be hampered by the presence of pelvic adhesions and anatomical distortion.