Fertility-sparing Surgery Research Articles

Management of malignant dysgerminoma of the ovary

The evolution of treatment for malignant ovarian germ cell tumors has been one of the most successful in the history of gynecologic oncology, with dysgerminoma as the most common type of malignant ovarian germ cell tumors. Since the introduction of platinum-based chemotherapy in the 1980s, 5-year survival rates for early-stage dysgerminomas have been close to 100%, and as high as 98% for advanced stages. Despite this remarkable achievement, many questions remain in routine treatment. By performing a literature review, we aim to highlight both the current treatment of malignant dysgerminoma and unanswered questions in the modern management of this disease. These issues relate firstly to surgical therapy, such as the role of routine omentectomy and lymphadenectomy, the value of complete surgical resection, and the possibility of fertility-sparing surgery. Second, chemotherapy and the question of the possibility of de-escalation in early stages and the potential of neoadjuvant chemotherapy in advanced stages will be addressed. Finally, a brief overview of the current developments of new drug treatment regimens will be given.

Giant immature teratoma in a 15 year old causing anti-n-methyl-d-aspartate (anti-nmda) receptor encephalitis-like and Guillain-Barré Syndrome as paraneoplastic manifestations: A case zreport

Germ cell tumor is the most prevalent ovarian tumor in young women between 10 and 30 years of age.[1] However, immature teratomas account for only 20% of the malignant ovarian tumors found in the adolescent age group.[2] More uncommon is the occurrence of immature teratoma causing anti-N-methyl-D-aspartate receptor (Anti-NMDAR) encephalitis and Guillain-Barré Syndrome (GBS). This is a case of a 15-year-old female, nulligravid, who initially presented sudden behavioral change and symmetrical weakness of both lower and upper extremities with concomitant seizure episodes and with palpable lower abdominal mass. The patient was diagnosed to have GBS and treated with intravenous immunoglobulin causing resolution of neurologic symptoms months after. During the management of GBS, the patient noted increasing abdominal girth. Tumor markers showed elevated alpha-fetoprotein, CA125, and lactate dehydrogenase. An imaging study revealed predominantly solid ovarian mass hence malignancy was considered. Once the medical condition stabilized, the patient underwent fertility-sparing surgery with the final histopathologic result of immature teratoma. The aim of this report is to present a case of anti-NMDAR encephalitis and GBS as paraneoplastic manifestation of immature teratoma.

Long term oncologic and reproductive outcomes after robot-assisted radical trachelectomy for early-stage cervical cancer. An international multicenter study

ObjectivesLong term outcomes following fertility sparing robot-assisted radical trachelectomy (RRT). MethodsA retrospective study of consecutive women selected for RRT between 2007 and 2019 at five referral centres. Generally used selection criteria for fertility-sparing surgery were applied. Oncologic, reproductive and long-term clinical data were analysed. ResultsOf the 166 included women, 149 completed a RRT. Median tumor size was 9 mm (range 3-20 mm), 111 women (75%) had FIGO 2009 stage IB1 cancer and 4.8% were node positive. At a median follow up of 58 months, 12 of all women (7.2%) and 9 of 149 women (6%) who underwent completed RRT with fertility preservation had recurred and two had died. 70 of 88 women (80%) who attempted to conceive succeeded, resulting in 81 pregnancies that progressed beyond the first trimester and 76 live births of which 54 (70%) were delivered at term and 65 (86%) delivered after gestational week 32. A short postoperative cervical length was associated with impaired fertility. A late secondary hysterectomy was necessary in four women due to persistent bleeding (n = 2), hematometra due to a cervical stenosis (n = 1) and recurrent dysplasia (n = 1). ConclusionIn this long-term follow-up of RRT the recurrence rate is comparable to larger individual studies of minimally invasive or vaginal radical trachelectomy with similar risk profile and follow up. The high pregnancy rate and low rate of premature delivery before 32 weeks GA may promote the use of robot-assisted approach.

Clinicopathological importance of survivin immunoexpression in reproductive age patients with serous borderline ovarian tumors

Purpose: The aim of the present study was to evaluate survivin immunoexpression and the clinicopathologic correlations in serous borderline ovarian tumors (BOT) patients ≤ 40 years old.
 Materials and Methods: A total of 36 BOT cases were evaluated. After excluding the mucinous type and patients over 40 years of age, 20 serous BOT cases meeting the criteria were included. A similar number of benign ovarian cysts and 20 serous malign ovarian tumors were randomly included as the control group. The patients were then staged based on their surgical findings and 2014 FIGO criteria, and their histological tumor types obtained from pathological specimens were determined using WHO criteria. The survivin levels in the specimens were analyzed using immunohistochemical assays.
 Results: Positive survivin expression was detected in 10% of benign tumors, 100% of serous BOTs, and 100% of serous malign ovarian tumors. Mean survivin immunoreactivity was statistically similar between groups and it was found to be significantly higher in both groups compared to the control group. Survivin expression was positively correlated with FIGO stage, tumor grade, microinvasion, and micropapillary pattern.
 Conclusion: Survivin immunoexpression is correlated with the malignancy potential of serous BOTs, and that survivin immune expression may be a histopathological marker that will help in making a decision on fertility-sparing surgery and follow upin young patients.

Fertility-sparing surgery for patients with stage IC2 or IC3 epithelial ovarian carcinoma: any evidence of safety?

ObjectiveInvestigate the overall survival of patients with stage IC2/IC3 epithelial ovarian carcinoma undergoing fertility-sparing surgery.MethodsPatients aged <45 years diagnosed between January 2004 and December 2015 with epithelial ovarian carcinoma, who...

Survival and reproductive outcomes after fertility-sparing surgery performed for borderline epithelial ovarian tumor in Japanese adolescents and young adults: Results of a retrospective nationwide study.

Epithelial borderline ovarian tumor (BOT) frequently occurs in young women. Because progression-free survival, overall survival, and reproductive function are important outcomes, BOT is often treated by fertility-sparing surgery (FSS). We conducted a Japan-wide study to understand post-FSS prognosis in relation to clinical characteristics and types of FSS performed. We analyzed clinical and outcome data pertaining to 531 adolescent and young adult (AYA) patients (aged 15-39 years) who underwent FSS for BOT between 2009 and 2013. Median (range) age was 30 (15-39) years, and median observation time was 70 (2-120) months. The disease was of FIGO stage I in 492 (93%) patients. Histopathologically, tumors were of the mucinous (n=372, 70%), serous (n=120, 23%), seromucinous (n=23, 4%), and other (n=16, 3%) types. Five-year overall survival was 99.5% among patients with stage I and 100% among those with stage II-IV. Five-year progression-free survival was 96.7% and 69.3%, respectively. Multivariate analysis in cases of stage I showed a positive peritoneal cytology to be a significant risk factor for recurrence (HR, 5.199; p=0.0188). The post-FSS pregnancy rate was relatively low for patients aged ≥30 years (OR, 0.868; 95% CI, 1.16-3.00; p=0.0090). Post-FFS outcomes in terms of overall and progression-free survival are favorable, especially for AYA patients with stage I BOT. However, the relapse rate is high for patients with FIGO stage II-IV and for those with stage I but a positive peritoneal cytology. A long-term prospective observation is needed before reproductive outcomes can be fully established.

Analysis of Outcomes and Prognostic Factors after Fertility-Sparing Surgery in Patients with Early Stage Juvenile Granulosa Cell Tumor of the Ovary: Experience from a Tertiary Center

Study ObjectiveThe objective of the study was to analyze the oncological outcomes and prognostic factors in patients with early-stage juvenile granulosa cell tumor (JGCT) who underwent fertility-sparing surgery. Design, Setting, and ParticipantsAll patients with early-stage JGCT who underwent fertility-sparing surgery between January 1995 and December 2017 were reviewed retrospectively. InterventionsNone. Main Outcome MeasuresThe risk factors for recurrence and death in patients with early-stage JGCT were identified. ResultsThirty-five patients were eligible for the current study. The median age was 17 years (range: 4-30 years), and 10 patients were premenarchal. Nine patients were International Federation of Obstetrics and Gynecology stage IA, and 26 were stage IC. Eight subjects underwent complete staging, whereas 28 had no staging at their initial surgery. In those without initial staging, 3 patients who received initial unilateral salpingo-oophorectomy (USO) and 6 with initial cystectomy underwent secondary surgery for staging or USO with staging, respectively. At the time of the secondary staging operation, 1 of the subjects (treated with USO at initial surgery) was found to be stage III and was excluded from this study. Therefore, 8 patients underwent secondary staging surgery performed by laparoscopic surgery, and none of them suffered recurrence during follow-up. Fourteen of the 16 patients with complete staging surgery underwent lymphadenectomy, and none of them had lymph node metastasis. Thirty-one patients received adjuvant chemotherapy after surgery. Eight patients had disease recurrence after a median follow-up time of 51 months (range: 6-229 months), with a median time to recurrence of 4.5 months (range: 2-52 months). Six patients died of their disease. The 5-year disease-free and overall survival rates were 74.8% and 84.3%, respectively. Univariate analysis showed that incomplete staging surgery was associated with increased risk of recurrence (P = 0.029). Adjuvant chemotherapy was not associated with disease-free survival. Four patients had a total of 6 pregnancies, resulting in 6 live births. ConclusionComplete surgical staging is recommended for early-stage JGCT, but lymph node dissection can be omitted. Laparoscopic restaging surgery is feasible for patients with incomplete staging at initial surgery. However, the prognosis of patients with relapsed JGCT remains poor.

Fever and Abdominal Pain in a 10-year-old with Autism.

Fever and Abdominal Pain in a 10-year-old with Autism.

New Aspects of Sarcomas of Uterine Corpus-A Brief Narrative Review.

Sarcomas of the uterine corpus are rare malignant neoplasms, which are further classified into mesenchymal tumors, and mixed (epithelial plus mesenchymal) tumors. The main issues concerning these neoplasms are the small number of clinical trials, insufficient data from evidence-based medicine, insignificant interest from the pharmaceutical industry, all of which close a vicious circle. The low frequency of these malignancies implies insufficient experience in the diagnosis, hence incomplete surgical and complex treatment. Additionally, the rarity of these sarcomas makes it very difficult to develop clinical practice guidelines. Preoperative diagnosis, neoadjuvant and adjuvant chemoradiation, target and hormone therapies still raise many controversies. Disagreements about the role and type of surgical treatment are also often observed in medical literature. There are still insufficient data about the role of pelvic lymph node dissection and fertility-sparing surgery. Pathologists’ experience is of paramount importance for an accurate diagnosis. Additionally, genetics examinations become part of diagnosis in some sarcomas of the uterine corpus. Some gene mutations observed in uterine sarcomas are associated with different outcomes. Therefore, a development of molecular classification of uterine sarcomas should be considered in the future. In this review, we focus on the epidemiology, pathogenesis, pathology, diagnosis and treatment of the following sarcomas of the uterine corpus: leiomyosarcoma, low- and high-grade endometrial stromal sarcomas, undifferentiated sarcoma and adenosarcoma. Uterine carcinosarcomas are excluded as they represent an epithelial tumor rather than a true sarcoma.

Long-Term Outcomes and Factors Related to the Prognosis of Pure Ovarian Dysgerminoma: A Retrospective Study of 107 Cases

Objective: The aim of this study was to evaluate the long-term outcomes and the factors related to patient prognosis. Materials and Methods: We retrospectively analyzed patients treated at the Department of Gynecology, Sun Yat-sen University Cancer Center, between January 1, 1968, and December 12, 2018. Results: A total of 107 patients were identified. Of all patients, 79 (73.8%) presented with stage I disease, 14 (13.1%) stage II, 13 (12.2%) stage III, and 1 (0.9%) stage IV. All patients received surgery, with 70 (65.4%) undergoing fertility-sparing surgery (FS) and 37 (34.6%) nonfertility-sparing surgery (NFS). Ninety patients received postoperative chemotherapy. Nine of the 43 cases with a lymphadenectomy had metastasis (20.9%). The median follow-up time was 132 months (range, 1–536 months). The overall 5-year and 10-year survival was 95.1% and 91.7%, respectively. The 10-year survival rate for stage I and II–IV patients was 96.1% and 79.1%, respectively (p = 0.008). For the patients undergoing FS and NFS, the 10-year disease-free survival rate was 82.3% and 88.0%, respectively (p = 0.403). The 10-year disease-free survival rate for patients with or without lymphadenectomy was 95.1% and 78.4%, respectively (p = 0.040), and it was 92.5% and 76.0%, respectively (p = 0.041), for those with or without omentectomy. Fifteen patients relapsed, and 4 of them (26.7%) had recurrence in the lymph nodes. Eleven of the 15 relapsed patients (73.3%) had been successfully salvaged. Limitations: As a study of a rare disease, our analysis was limited by its small sample size and the deemed disadvantage of a retrospective study. Conclusion: Excellent treatment results can be achieved in dysgerminoma patients who received proper treatment. Lymphadenectomy may improve patient survival. Relapsed patients can also be successfully salvaged.

Long-term post-recurrence survival outcomes in young women receiving fertility-sparing surgery for epithelial ovarian cancer

ObjectiveThe aim of this study was to investigate long-term post-recurrence survival outcomes in young women receiving fertility-sparing surgery (FSS) to verify the feasibility of the limited surgery for epithelial ovarian cancer (OvCa). Study designWe performed a regional multicenter retrospective study from January 1986 and March 2020, using clinical data corrected under the central pathological review system. Patients with recurrent tumor after surgery for stage I epithelial OvCa, aged equal or younger than 45 years were included for this study. We evaluated effect of FSS regarding long-term post-recurrence survival with statistical adjustment of propensity score-based method. ResultsWith the Kaplan–Meier method, original and adjusted survival curves were estimated for recurrence-after survival of patients with (n = 14) and without FSS (n = 26). Median time to disease-specific death was 18.6 months. In both original and adjusted cohorts, there were no significant difference between the two groups (log rank test; P > 0.05). Hazard ratio of disease-specific death was 1.264 (95% confidence interval, 0.563–2.836; P = 0.570) in original and 1.354 (95% confidence interval, 0.702–2.611; P = 0.366) in adjusted population. This result indicated that patients with FSS was not associated with poorer prognosis for recurrence-after survival than those without. When comparing patients not receiving FSS, patients receiving FSS with recurrence at spared ovary followed not significantly different survival outcome as well as those with extra-ovarian recurrence. ConclusionThere was no significant difference of long-term post-recurrence survival outcomes between patients of epithelial OvCa with and without FSS in young women of reproductive age.

Fertility-sparing management of a suspicion of leiomyosarcoma: avoiding hysterectomy by performing transcervical myoma biopsy

To describe the fertility-sparing management of an atypical uterine myoma.Step-by-step video explanation of transcervical biopsy using transabdominal ultrasound guidance, highlighting tips and tricks. Patient consent was obtained before the publication of the case.University hospital.A 32-year-old nulliparous woman with a history of dysmenorrhea was found to have an atypical myoma FIGO 6, with suspicion of leiomyosarcoma on magnetic resonance imaging.A transcervical biopsy of an atypical myoma was done under transabdominal ultrasound guidance. A myomectomy by a minimally invasive approach was performed without morcellation.Feasibility of transcervical biopsy and correlation with definitive anatomopathological diagnosis.The patient was under general anesthesia. A hysteroscopy confirmed the normal appearance of the uterine cavity with no direct access to the myoma. Four core biopsies were performed with a 16-gauge needle transcervically under ultrasound guidance. The preliminary diagnosis of cellular leiomyoma allowed a fertility-sparing surgery. Myomectomy and surgical treatment of endometriosis were performed secondarily. This patient had a successful recovery, and the diagnosis of benign cellular leiomyoma was confirmed on the surgical specimen.The current video highlights the safety and feasibility of transcervical ultrasound-guided core biopsy in patients with atypical uterine fibroids.

Characteristics and outcomes analysis of ovarian Sertoli\u2013Leydig cell tumors (SLCTs): analysis of 15 patients

IntroductionBecause of limited information of Sertoli–Leydig cell tumors (SLCTs), the objective aimed to describe clinical parameters, management and treatment results of SLCTs.Material and methodsWe retrospectively reviewed 15 cases with SLCTs, who were treated in the Affiliated Hospital of Qingdao University between 2009 and 2020. Data of clinical parameters and treatment was studied.ResultsThe age ranged 25–69 years. Elevated testosterone was observed in 4 patients. FIGO-stage: 14 were at Ia(10 moderately differentiated, 3 poorly differentiated, 5 retiform pattern).1 was at Ic. Patients with retiform pattern were more likely to exhibit endocrine function (p = 0.019, w = 0.61) and tumor diameter was significantly bigger in no endocrine function (p = 0.012, d = 1.52). All patients received surgical treatment. 8 received postoperative chemotherapy. The median follow-up was 66 months (20–112 months). 1 patient relapsed within 36 months and received cytoreductive surgery. She survived without disease after recurrence treatment. Of 5 patients who performed fertility sparing surgeries with the desire of childbirth, 3 had full-term pregnancy and 1 experienced a miscarriage. Another one has not tried to conceive.ConclusionThe prognosis of SLCTs is good. Our data showed patients with retiform pattern were more likely to exhibit endocrine function. The diameter of tumor was significantly bigger in no endocrine function. Conservative surgery is the preferred option for patients with the desire of fertility at stage Ia. Postoperative chemotherapy is advised to cases with high-risk factors, but the most effective chemotherapy regimen is still uncertain.

Ovarian Serous Surface Papillary Borderline Tumor: Sea Anemone Sign

HomeRadioGraphicsVol. 41, No. 7 PreviousNext Cases from the Cooky JarFree AccessOvarian Serous Surface Papillary Borderline Tumor: Sea Anemone SignC. Austin Wheeler , Ciléin Kearns, Valery L. Turner, Tushar R. GargC. Austin Wheeler , Ciléin Kearns, Valery L. Turner, Tushar R. GargAuthor AffiliationsFrom the Department of Radiology, University of Alabama at Birmingham School of Medicine, 619 19th Street S, JT N338, Birmingham, AL 35249 (C.A.W.); Medical Research Institute of New Zealand, Wellington, New Zealand, and Artibiotics, Wellington, New Zealand (C.K.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (V.L.T.); and Department of Radiology, Seth GS Medical College and KEM Hospital, Parel Mumbai, Maharashtra, India (T.R.G.).Address correspondence to C.A.W. (e-mail: [email protected]).C. Austin Wheeler Ciléin KearnsValery L. TurnerTushar R. GargPublished Online:Nov 1 2021https://doi.org/10.1148/rg.2021210201MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In On the pathway from benign cystadenoma to malignant cystadenocarcinoma, borderline tumors represent a crucial entity within the spectrum of ovarian epithelial carcinogenesis. Of this class, serous borderline neoplasms represent the common subclass (65%) (1).One distinct sub-subclass is named serous surface papillary borderline tumor (SSPBT) for its unique (although not wholly exclusive) imaging features (2) (Figs 1–3). Macroscopically, its surface stroma frequently branches into exophytic papillary stalks; hence the name. When these cystic lesions form frondlike excrescences, they mimic the likeness of a sea anemone at MRI (1,2). Histopathologic analysis even recapitulates this architectural pattern with micropapillary tumor cell proliferation.Figure 1. Classically described sea anemone appearance of a borderline serous surface papillary tumor in a 52-year-old woman. (A) Axial postcontrast T1-weighted MR image of the pelvis demonstrates heterogeneous soft-tissue enhancement with multiple enhancing fronds (arrow). (B, C) Axial (B) and sagittal (C) T2-weighted MR images of the pelvis demonstrate a complex T2-hyperintense adnexal tumor with multiple papillary excrescences (arrow).Figure 1.Download as PowerPointOpen in Image Viewer Figure 2. (A, B) Gray-scale (A) and color Doppler (B) transvaginal US images in a 52-year-old woman (same patient as in Fig 1) show that this mass has internal echogenic content with a branching appearance (arrow in A) and internal vascularity (arrowhead in B). (C) Low-power photomicrograph (hematoxylin-eosin stain) used for histologic correlation shows that epithelial ovarian tumor cells grow as papillary structures (P) in a hierarchical fashion (large, medium, and small papillae). Tumor cells composing papillae are of serous type with eosinophilic cytoplasm and mild to moderate nuclear atypia. No mitotic activity is seen in this case. (Fig 2C courtesy of Longwen Chen, MD, PhD.)Figure 2.Download as PowerPointOpen in Image Viewer Figure 3. Medical illustration shows the sea anemone sign, which features papillary fingerlike projections with internal branching. Associated findings may include coarse calcifications, ascites, para-aortic lymphadenopathy, and spread to the peritoneum. (Reprinted, with permission, from Ciléin Kearns, Artibiotics, Copyright © 2021.)Figure 3.Download as PowerPointOpen in Image Viewer Preoperative detection at diagnostic imaging can be informative because less aggressive borderline tumors tend to carry a more favorable prognosis, potentially altering management. Early identification and treatment are vital, as these tumors commonly manifest in younger women of childbearing age who may benefit from fertility-sparing surgery (1).All authors have disclosed no relevant relationships.

Abdominal Radical Trachelectomy.

Abdominal radical trachelectomy is a fertility-sparing surgery for early invasive cervical cancer. The surgical steps involved in abdominal radical trachelectomy are similar to those for radical hysterectomy prior to removal of the uterus. The difference is that in trachelectomy, the uterine corpus and infundibulopelvic ligament are conserved and the cervical remnant is connected to the vaginal wall. Surgeons should pay close attention to avoiding postsurgical complications such as infection and ileus, which might interfere with subsequent fertility treatments.

Cervical Cancer and Fertility-Sparing Treatment.

Radical hysterectomy with pelvic node dissection is the standard treatment for early-stage cervical cancer. However, the latter can be diagnosed at a young age when patients have not yet achieved their pregnancy plans. Dargent first described the vaginal radical trachelectomy for patients with tumors <2 cm. It has since been described a population of low risk of recurrence: patients with tumors <2 cm, without deep stromal infiltration, without lymphovascular invasion (LVSI), and with negative lymph nodes. These patients can benefit from a less radical surgery such as conization or simple trachelectomy with the evaluation of the pelvic node status. Tumors larger than 2 cm have a higher risk of recurrence and their treatment is a challenge. There are currently two options for these patients: abdominal radical trachelectomy or neoadjuvant chemotherapy (NACT), followed by fertility-sparing surgery. All patients who wish to preserve their fertility must be referred to expert centers.

Fertility Sparing Treatment in Gastric-Type Endocervical Carcinoma.

Simple SummaryDue to a trend toward late childbearing, fertility preservation has become a major issue in young patients with gynecological cancer. Surgical fertility sparing management is universally acknowledged as an acceptable option in eligible patients with cervical cancer. Excisional cone biopsy or trachelectomy are now standard surgical procedures offered to selected patients with gynecological malignancies who wish to preserve their fertility. Neoadjuvant chemotherapy followed by surgery is another therapeutic option studied currently in numerous clinical trials. However, fertility preserving treatment is generally not recommended in rare histological types of cervical cancer, including clinically aggressive gastric-type endocervical carcinoma. Due to controversies in this emerging topic, a review of literature and international database was carried out, in search of solid evidence on fertility sparing management in gastric-type endocervical carcinoma.Fertility sparing management of cancer is one of the main components of quality-of-life issues. Early-stage cervical cancer, frequently diagnosed in women of reproductive age, can potentially be treated conservatively. However, some rare histological types of cervical cancer present with aggressive clinical behavior. Particularly, in the newly introduced concept of gastric-type endocervical carcinoma, fertility sparing management is ‘a priori’ not recommended. Even so, this issue remains undocumented. For this reason, a selected review of the current literature on gastric type endocervical carcinoma was carried out through PubMed. The keywords included “gastric-type cervical cancer”, “gastric-type endocervical carcinoma”, “conservative surgery”, “conservative treatment”, “fertility sparing surgery”, “radical trachelectomy”, “laparoscopic trachelectomy”, “robotic trachelectomy”, “laparotomic trachelectomy”, “abdominal trachelectomy”, “trachelectomy”, “neoadjuvant chemotherapy”, “conisation”, and “cone resection”. A search in the European Network on Cancer, Infertility and Pregnancy (INCIP) database was performed. The rarity of gastric-type endocervical carcinoma does not allow for conclusions on fertility sparing management with solid evidence. However, diffuse character of the disease and aggressive clinical behavior contraindicate a conservative treatment in young women with gastric type cervical cancer.

Robotic-Assisted Laparoscopic Fertility Sparing Surgery for Treatment of Early-Stage Cervical Cancer

<h3>Study Objective</h3> To explore the safety, feasibility and pregnancy outcome of da Vinci robotic-assisted laparoscopic fertility-sparing surgery for early-stage cervical cancer. <h3>Design</h3> Retrospectively review clinical data of 10 patients who underwent robotic-assisted radical trachelectomy with bilateral lymphadenectomy between January 2018 and February 2020 in our center. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> The mean age of the 10 patients was 29.6±3.0 years old and the mean BMI was 23.9±3.7 kg/m². Among them, 1 patient was in stage IA1 with lymph-vascular space invasion, 2 patients in stage IA2 and 7 patients in stage IB1. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> The average operative time was 295±21 min. The average estimated amount of intraoperative blood loss was 65±18 ml, and the average number of lymph nodes removed was 28.6±3.5. The length of parametrial tissue removed on the left side was 34.3±1.6 mm and 33.9±1.5 mm on the right side. No intraoperative complications occurred. Postoperatively, the length of cervix (measured by transvaginal ultrasound) was 7.1±1.7 mm. The average length of hospital stay was 7.7±2.0 days. The median follow-up was 23.9 months. One patient had lymphocele 2 months after the operation. No recurrence happened during the follow-up period. Three patients achieved pregnancy, including 2 natural pregnancy and 1 assisted-reproductive pregnancy. One woman with natural pregnancy 11 months postoperatively delivered a healthy female infant at 38⁺¹ weeks. <h3>Conclusion</h3> Robotic-assisted radical trachelectomy is a safe and feasible alternative for cervical cancer patients who desire fertility preservation. Its long-term oncologic outcome and pregnancy outcome require further investigation.

Pre-Operative Magnetic Resonance Imaging (MRI) and Surgical Management of Endometriosis

Study Objective To demonstrate how interdisciplinary collaboration between Radiology and Minimally Invasive Gynecologic Surgery departments can address pre-operative challenges in patients undergoing surgical management of endometriosis. Design Radiology review of imaging pre-operatively and subsequent retrospective review of completed surgical cases by surgeons with intra-operative photography and video. Setting Bimonthly conferences with members of both departments present. Patients or Participants De-identified patients with complex endometriosis on MRI who were planned for surgical management Interventions Review of MRI using separation by compartments and detailed description and measurements of lesions prior to surgery to improve patient counseling and recruitment of appropriate surgical services. Measurements and Main Results Surgical videos demonstrate planned removal of lesions. Contribution of MRI conference to individual patient cases is discussed along with how this helps address specific pre-operative challenges in endometriosis patients. Development of standardized MRI templates is ongoing. Conclusion Interdisciplinary collaboration is an important aspect of patient care when managing complex endometriosis with excisional fertility-sparing surgery. Patient counseling on planned surgery and risks can be improved with precise detection and standardized reporting using pre-operative imaging such as MRI. Scheduled pre-operative review of MRI provides the ability to address these clinical concerns. By correlating imaging, clinical, and intra-operative findings, we hope to improve patient outcomes. To demonstrate how interdisciplinary collaboration between Radiology and Minimally Invasive Gynecologic Surgery departments can address pre-operative challenges in patients undergoing surgical management of endometriosis. Radiology review of imaging pre-operatively and subsequent retrospective review of completed surgical cases by surgeons with intra-operative photography and video. Bimonthly conferences with members of both departments present. De-identified patients with complex endometriosis on MRI who were planned for surgical management Review of MRI using separation by compartments and detailed description and measurements of lesions prior to surgery to improve patient counseling and recruitment of appropriate surgical services. Surgical videos demonstrate planned removal of lesions. Contribution of MRI conference to individual patient cases is discussed along with how this helps address specific pre-operative challenges in endometriosis patients. Development of standardized MRI templates is ongoing. Interdisciplinary collaboration is an important aspect of patient care when managing complex endometriosis with excisional fertility-sparing surgery. Patient counseling on planned surgery and risks can be improved with precise detection and standardized reporting using pre-operative imaging such as MRI. Scheduled pre-operative review of MRI provides the ability to address these clinical concerns. By correlating imaging, clinical, and intra-operative findings, we hope to improve patient outcomes.

Efficiencies in Robotic Radical Trachelectomy

<h3>Study Objective</h3> To demonstrate an efficient and stepwise approach to performing a robotic radical trachelectomy. <h3>Design</h3> Video description of dissection of the retroperitoneal space and identification of key structures, the nerve sparing technique, creation of a deep and lateral bladder flap, cerclage placement and specimen removal, and reapproximation of the vagina to the uterus. Patient provided consent for the video and publication. This video with no identifying patient data was exempt from Institutional Review Boards Approval. <h3>Setting</h3> Robotic-assisted laparoscopy was performed. <h3>Patients or Participants</h3> We present a patient with early-stage cervical adenocarcinoma who was an appropriate candidate for fertility-sparing surgery. <h3>Interventions</h3> After the right retroperitoneum space is entered, key landmarks are noted. After finding the ureter, the paravesical and obturator spaces were created. The superior vesical artery, obturator nerve, and uterine artery are identified and dissected. The ureter is dissected off the flap to the level of the right uterine artery and uterosacral ligament. The rectovaginal septum is then dissected as the next natural field. The same steps are repeated on the left side. The bladder flap is created, making sure that it is both deep and lateral for easier dissection of the vesicovainal ligament and visualization during robotic surgery. The uterocervical junction is incised circumferentially. The round ligaments and uterine manipulator are left in place to aid in the placement of the cerclage, removal of the specimen, and suturing of the vagina to the uterus. <h3>Measurements and Main Results</h3> Utilizing these efficiencies resulted in a shorter operative time of 2 hours and 38 minutes (versus 5 hours and 8 minutes) in this robotic radical trachelectomy. <h3>Conclusion</h3> The efficiencies were the following: an orderly fashion in going from field to field which resulted in less movements, dissecting the bladder flap deep and lateral which aided in taking down the vesicovaginal ligament and visualization, and utilizing the uterine manipulator throughout the case.