Small-Diameter Hysteroscopic Metroplasty for a Septate Uterus after Open-Assisted Laparoscopic Radical Trachelectomy

Abstract

Study ObjectiveTo describe a 2-step fertility preservation technique for early-stage cervical cancer of a patient with a complete septate uterus. DesignA step-by-step demonstration and explanation of the technique in a surgical video (Canadian Task Force classification III). SettingCenter for cancer, a tertiary referral center. Institutional Review Board approval was not required for this kind of procedure. PatientA 37-year-old woman. The patient provided informed consent to use images and videos of the procedure. InterventionsOpen-assisted laparoscopic radical trachelectomy (LRT) after metroplasty. Measurements and Main ResultsA 37-year-old woman presented with early-stage cervical cancer and a complete septate uterus. She desired fertility preservation. After careful counseling and in accordance with her wishes for fertility-sparing surgery, open-assisted LRT after metroplasty were scheduled. First, LRT was successfully completed, and a cervical cerclage using permanent Ethibond sutures (Ethicon, Inc, Somerville, NJ) was doubly inserted around the level of the internal os with a Hegar size 8 dilator to maintain patency. At 6 months after this procedure, magnetic resonance imaging (MRI) revealed no sign of recurrence. Then, metroplasty without dilatation of the cervical os was performed using a small-diameter (5.2-mm) resectoscope system (Karl Storz GmbH & Co. KG, Tuttlingen, Germany), scissor forceps, bipolar electrode, and normal saline. A hysteroscope was inserted without gripping the neocervix, and the septum was then resected with scissor forceps. The septum was cut from the cervical to the fundal side. Finally, an intrauterine device was placed in the uterine cavity to prevent adhesion in the uterine cavity. Three months later MRI confirmed normal development of the whole endometrium. No intraoperative or postoperative complications occurred. ConclusionsThis 2-step fertility preservation technique with a small-diameter hysteroscopy presents an effective alternative to the traditional resectoscope technique. Further analyses with long-term follow-up are warranted to evaluate this surgical method.