Laparoscopic Radical Trachelectomy Research Articles

Surgical Technique Variation for the Laparocopic Radical Trachelectomy Through the Initial Development of the Pararectal Spaces and Isolation of the Hypogastric Nerves

Video Objective Demonstrate a surgical technique variation for the laparoscopic radical trachelectomy by initiating the procedure through the development of the pararectal space and the identification of the hypogastric nerve. Setting A 26 years-old patient was diagnosed with a papillary squamous cell carcinoma of the uterine cervix – (FIGO - stage IB1) Interventions With the advancement of surgical techniques in frozen pelvis for the treatment of deep endometriosis - we, from the School of Minimally Invasive Surgery from the Crispi Institute (Brazil), adopted a systematic approach, as to always initiate with the dissection of the pararectal space at the level of the promontory, medializing the mesorectal fascia and lateralizing the hypogastric nerve, along with the endopelvic fascia. We follow this dissection caudally towards the pelvic floor – establishing the “base” for the known spaces – Okabayashi, Latsko and paravescial. With the lateralization of the ureter, the isolation of the hypogastric nerve is facilitated and resection of the uterosacral ligaments is performed. Next, the development of the rectovaginal septum and the dissection of the loose areolar tissue can be accomplished – maintaining the adipose tissue attached to the intestinal wall. After medializing and tunelizing the ureter, we develop the Latsko space, communicating this region to the “base” of the pararectal space, previously established. Next, we can easily dissect the paravesical space, opening the anterior leaflet of the broad ligament, medializing the vesical wall until we reach the floor of the pararectal space. By medially dissecting the obliterated umbilical artery, we develop the lateral paravesical spaces. Connecting the right and left spaces, through the anterior compartment, we resect the vesical pillars and develop the Yabuki and vesicovaginal spaces. After developing all the spaces and isolating the hypogastric nerves, we follow the trachelectomy as usual. Conclusion This is a viable and secure approach to initiate a trachelectomy.

The Surgical Morbidity And Oncological Outcome Of Total Laparoscopic Radical Trachelectomy Versus Total Laparoscopic Radical Hysterectomy For Early Stage Cervical Cancer: A Retrospective Study With 11-Year Follow-Up.

ObjectiveThe objective of this study was to evaluate the surgical morbidity and oncological outcome of total laparoscopic radical trachelectomy (TLRT) and total laparoscopic radical hysterectomy (TLRH) in patients with early-stage cervical cancer.MethodsWe performed a retrospective study to compare the outcomes of patients with stage IB1 cervical cancer who underwent TLRT to patients treated with TLRH from January 2005 to December 2016.ResultsForty-six patients underwent TLRT and 73 patients underwent TLRH between January 2005 and December 2016. The median age was 30 (19–40) years for TLRT group compared to 43 (31–65) years for TLRH group. No significant difference was found for the tumor size, histology, and pathology grade between TLRT group and TLRH group. In the TLRT group, the median operative time was 200 mins (range, 150–360 mins) and the median blood loss was 200 mL (range, 50–400mL). In the TLRH group, the median operative time was 240 mins (range, 180–380) and the median blood loss was 250mL (range, 10–1500mL). The median follow-up time was 80 months for TLRT group and 72 months for TLRH group. No patient in TLRT group developed recurrence. However, there were 2 recurrences diagnosed in the TLRH group.ConclusionTLRT appears to have equal surgical morbidity and oncological outcome to TLRH in stage IB1 cervical cancer. Intraoperative complications did not differ significantly between these two groups. However, postoperative complications were fewer observed in TLRT. Because of the natural limitations of the retrospective study, the clinical value should be confirmed by multi-institutional prospective trial in the future.

A Case of Successful Spontaneous Pregnancy after Laparoscopic Radical Trachelectomy with Trans-Abdominal Cervicoisthmic Cerclage Treatment

A Case of Successful Spontaneous Pregnancy after Laparoscopic Radical Trachelectomy with Trans-Abdominal Cervicoisthmic Cerclage Treatment

Rubbing salt on the wound.

The quotation ‘People who peek through key-holes have to expect an occasional poke in the eye’ comes to mind in view of the recently published LACC Trial in the New England Journal of Medicine showing significantly worse survival following ‘keyhole’ surgery (laparoscopic or robotic) in early stage cervical cancer (Ramirez et al. N Engl J Med 2018;379:1895–904). A second study in the same edition reinforced the results by also showing a worse survival with ‘keyhole’ surgery (Melamed et al. N Engl J Med 2018;379:1905–14). This must be considered to be as unfortunate as having ‘both eyes poked at the same time via the same keyhole’. Before gynaecological oncologists have regained full sight, comes this third publication focusing on fertility-sparing surgery in early stage cervical cancer which ‘rubs salt on the wound’ by also showing excellent survival with an abdominal approach. The study by Li et al. (BJOG 2019; 126:1169–74) the largest published series on abdominal radical trachelectomy (ART) demonstrating a 98.6% 5-year survival, agrees well with the abdominal arm in the LACC trial of 99% 3-year survival and contrasts significantly with the laparoscopic arm of 93.8% 3-year survival. In addition, the results are comparable to previous publications on ART and add substantially to the literature (previously, 866 cases with a cumulative mortality rate of 1.4%). Of interest are the results on tumours larger than 2 cm with a recurrence rate of 5.3% compared with 2.0% in tumours <2 cm (nonsignificant P value). Analysis of the New England Journal of Medicine publications identified that it was in this sub-group specifically there were the greatest differences in recurrences. It is also in this sub-group that survival differences are the greatest compared with vaginal radical trachelectomy (cumulative recurrence rate of 23.9%), which also utilises a laparoscopic approach (BJOG 2019;126:1169–74). Data following total laparoscopic radical trachelectomy are limited. Consistent with this, is the FIGO 2018 re-classification of cervix cancer reducing the cut-off between IB1 and IB2 tumours from 4 to 2 cm (Bhatla et al. Int J Gynaecol Obstet 2018;143 (Suppl 2):22–36). Where does all this leave us? Is the problem the surgeon or the tools or the procedure? Many are questioning the surgical techniques in order to retain a minimally invasive approach including the use of manipulators, the CO2 pneumoperitoneum, tumour exposure to the peritoneum and the surgical radicality. It's also time to reflect. Fertility-sparing or not, why have different surgeons/centres been advocating different surgical procedures/approaches? One explanation is the Collingridge dilemma stating that technological advances contain two components; (1) information: where the effects of technological advances cannot be predicted until they are extensively developed and widely used in clinical practice, and (2) power: where control (by the use of robust clinical evaluations) is difficult when the technology has become entrenched (Collingridge. The Social Control of Technology. London, UK: Palgrave Macmillan, 1981). This is highlighted by the Pacing problem, where innovations develop exponentially while control mechanisms develop incrementally. The solution would be the Precautionary principle, where innovations should not be embraced until developers can prove they will not cause harm. Critics argue this will not eliminate innovations developing in the wrong direction but result in no innovations developing at all. Although it is painful to have to revert back to an abdominal route, the solace is that ‘rubbing salt on the wound’, regardless of the additional pain, will help the wound recover faster. And so, for women with a stage IB2 cervical tumour (FIGO 2018) who wish to preserve fertility, the recommended operation should be an ‘abdominal’ radical trachelectomy. None declared. A completed disclosure of interests form is available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Type B Laparoscopic Radical Trachelectomy with Uterine Artery Preservation for Stage IB1 Cervical Cancer

Radical trachelectomy has emerged as a valuable fertility-preserving treatment option for young women with early-stage cervical cancer [1]. Laparoscopic radical trachelectomy performed by trained surgeons can be a feasible and safe therapeutic option as a fertility-sparing surgical technique [2,3]. To the best of our knowledge, this is the first time the total laparoscopic approach of radical trachelectomy is being published. In this video, rather than the description of the technique step by step, we show how to conserve uterine arteries even if the importance of such conservation is questionable. A case report. A tertiary referral center in Strasbourg, France. A 37-year-old patient with no medical history who presented with stage IB1 invasive epidermoid cervical cancer. In this video, we describe the fertility-sparing surgical procedure consisting of type B total laparoscopic radical trachelectomy with uterine artery preservation. The procedure consists of the following 10 steps: step 1, bilateral pelvic lymphadenectomy and opening of the para vesical fossa; step 2, opening of the pararectal fossa in between the ureter and the internal iliac artery on each side; step 3, ureteric dissection up to the ureteric canal; step 4, opening of the vesicouterine space and section of the vesicouterine ligament; step 5, posterior dissection with division of the uterosacral ligament approximately 20 mm from the uterine insertion; step 6, section of the descending branch of the uterine artery and skeletonization of the ascending branch up to the uterine isthmus level; step 7, trachelectomy with a monopolar hook; step 8, laparoscopic isthmovaginal stitches; step 9, laparoscopic cerclage; and step 10, peritoneal closure. The operative time was 420 minutes. The intraoperative blood loss was <200 mL. The operation was performed successfully with no intraoperative complications. The resection margins were safe. The patient was discharged on day 4. After 2 months, no late complications or recurrence were detected, and the patient had normal menstruation. Type B laparoscopic radical trachelectomy with uterine artery preservation appears to be a safe option for women who intend to maintain their desire for a future pregnancy.

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

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.

Four Surgical Approaches to Cervical Excision During Laparoscopic Radical Trachelectomy for Early Cervical Cancer

Study ObjectiveTo compare the clinical and oncological outcomes of four different approaches of cervical excision (CE) during radical trachelectomy (RT) for early cervical cancer. DesignA retrospective comparative observational study was performed at Gynecology Department of the Hospital Italiano de Buenos Aires in Buenos Aires, Argentine. The study was composed of all consecutive women who had undergone laparoscopic RT for early cervical cancer between May 2011 and July 2016. They were divided in four groups according with different surgical approaches to perform the CE during RT; which are also detailed. (Canadian Task Force Classification III). SettingTertiary care hospital. InterventionCE during radical trachelectomy for early cervical cancer. Measurement and Main ResultsA total of 7, 6, 6 and 3 patients undergone Type A, B, C and D cervical excision during RT, respectively. No significant differences in terms of age, BMI, surgical time and length of hospital stay were found according with different types of CE. Patients in Type D had, however, a significantly higher EBL, p =.006. Similar histology characteristics in terms of histology type, tumor grade and size, as well as lymph node count were observed among groups. Only grade 1-2 postoperative complications were noted in 9 patients. One local recurrence after Type B CE was treated with radical surgery plus chemoradiaton; while other patient after Type A CE relapsed with peritoneal carcinomatosis managed with chemotherapy. ConclusionDifferent types of cervical excision that are here described should be used according to each case based on specific clinical factors.

Total laparoscopic radical trachelectomy in early cervical cancer: review of the outcomes from a ‘Buddy’ Operating Institute

Total laparoscopic radical trachelectomy in early cervical cancer: review of the outcomes from a ‘Buddy’ Operating Institute

Northern Irish Experience of Total Laparoscopic Nerve Sparing Radical Trachelectomy: National Data on Surgical, Oncological and Reproductive Outcomes

Northern Irish Experience of Total Laparoscopic Nerve Sparing Radical Trachelectomy: National Data on Surgical, Oncological and Reproductive Outcomes

21. Total laparoscopic radical trachelectomy as a fertility sparing technique in early cervical cancer in a ‘Buddy’ operating institute: Demonstration of technique and review of outcomes

21. Total laparoscopic radical trachelectomy as a fertility sparing technique in early cervical cancer in a ‘Buddy’ operating institute: Demonstration of technique and review of outcomes

Utility of indocyanine green (ICG) intra-operative angiography to determine uterine vascular perfusion at the time of radical trachelectomy

ObjectivesThe aim of our study was to measure and analyze uterine perfusion utilizing laser angiography with ICG during uterine artery sparing and non-sparing radical trachelectomy. MethodsData were collected from all patients diagnosed with early-stage cervical cancer that underwent laser angiography with ICG during open or laparoscopic radical trachelectomy from June 2012 to December 2015. Regression analysis was use to determine the p values and R-squares on fluorescence, surgical time, hospital stay, age and BMI; a p-value<0.05 was considered statistically significant. ResultsA total of 20 patients met the inclusion criteria and were included in this study. Ten patients underwent uterine artery-sparing surgery, and ten patients underwent uterine artery non-sparing surgery. The most frequent stage for the entire cohort was IA2 (55%), and the most common histologic subtype was squamous cell carcinoma (49%). Lymph-vascular invasion was noted in 30% of the patients. There was no statistical significance difference in the mean ICG fundal fluorescence intensity between the uterine artery-sparing group 162.5 (range, 137–188) and the uterine artery non-sparing group 160.5 (range, 135–186), p=0.22. In both groups, 100% of the patients regained their menstrual function by postoperative week 8. A total of 4 (40%) pregnancies have occurred in the uterine artery-sparing group and 3 (30%) in the non-uterine artery-sparing group. ConclusionsBased on our real-time intraoperative angiography observations, there is no need to preserve the uterine artery during radical trachelectomy to maintain uterine viability.

Laparoscopic radical trachelectomy for preservation of fertility in early cervical cancer. A case report

Abstract Background Radical hysterectomy is the standard treatment for patients with early-stage cervical cancer. However, for women who wish to preserve fertility, radical trachelectomy is a safe and viable option. Objective To present the first case of laparoscopic radical trachelectomy performed in the National Cancer Institute, and published in Mexico. Clinical case Patient, 34 years old, gravid 1, caesarean 1, stage IB1 cervical cancer, squamous, wishing to preserve fertility. She underwent a laparoscopic radical trachelectomy and bilateral dissection of the pelvic lymph nodes. Operation time was 330 min, and the estimated blood loss was 100 ml. There were no intraoperative or postoperative complications. The final pathology reported a tumour of 15 mm with infiltration of 7 mm, surgical margins without injury, and pelvic nodes without tumour. After a 12 month follow-up, the patient is having regular periods, but has not yet tried to get pregnant. No evidence of recurrence. Conclusions Laparoscopic radical trachelectomy and bilateral pelvic lymphadenectomy is a safe alternative in young patients who wish to preserve fertility with early stage cervical cancer.

Type B Laparoscopic Radical Trachelectomy With Pelvic Lymphadenectomy for Early Cervical Cancer

Study ObjectiveTo demonstrate the technique of laparoscopic radical trachelectomy (LRT) and laparoscopic pelvic lymphadenectomy for early cervical cancer. DesignCase report (Canadian Task Force Classification Study design III). SettingTertiary referral centre in Strasbourg, France. BackgroundOver the past 15 years, gynecologic oncologists have sought ways to preserve female fertility when treating invasive cervical cancer. Many cases of cervical cancer have been diagnosed in young women with a desire to preserve their fertility. As more women are delaying childbearing, fertility preservation has become an important consideration. Radical hysterectomy and bilateral pelvic lymphadenectomy represent the standard surgical treatment for stage IA2-IB1 cervical cancer. In some women with small localized invasive cervical cancer, there is hope for a pregnancy after treatment. Vaginal radical trachelectomy (VRT) is a fertilitypreserving surgical procedure for early-stage cervical cancers. The National Comprehensive Cancer Network has published guidelines stating that radical trachelectomy is part of the standard of care for women desiring to preserve their future fertility. VRTwas introduced in 1987 with its first reported use in 1994, and since then more than 1000 cases of VRT have been reported involving more than 250 live births. The tumor recurrence rate is between 4.2% and 5.3%, and the mortality rate is between 2.5% and 3.2%. However, VRT has several limitations despite results demonstrating the safety of the procedure. One limitation is that it is an inadequate procedure for nulliparous patients and those with history of previous conization with adverse vaginal anatomy. In addition, it is difficult to learn the techniques involved in radical vaginal surgery. PatientsA 26 year-old nulliparous women with a FIGO Stage IB1 squamous cell tumor of the cervix. A first conisation was performed with no safe resection margins. InterventionIn this video we show a type B laparoscopic radical trachelectomy with round ligament and uterine artery preservation. A laparoscopic pelvic lymphadenectomy was also performed. Our institutional review board approved this study. Measurements and Main ResultsOperative time was 240 minutes. Intraoperative blood loss was less than 100 mL. The operation was performed successfully with no intraoperative complications. Pathological findings demonstrated the presence of a cervical intraepithelial neoplasia 2 on the anterior lips from an 11 o'clock to a 1 o'clock position. Resection margins were safe. The surgical specimen did not show any residual invasive carcinoma. Twenty one lymph nodes were removed, 7 on the right side, and 14 on the left side. No metastatic adenopathy was found. The patient was discharged on day 11. After 5 months, no late complications or recurrence was detected. ConclusionsLRT appears to be a safe option for women who intend to maintain their desire for a future pregnancy.

Reproductive and oncologic outcome following robot-assisted laparoscopic radical trachelectomy for early stage cervical cancer

ObjectiveTo investigate the reproductive and oncologic outcome following robotic radical trachelectomy for early stage cervical cancer. MethodsAll women with early stage cervical cancer planned for fertility-sparing robotic trachelectomy between December 2007 and April 2015 at two tertiary referral centers in Sweden were identified. Perioperative- and follow-up data was retrieved from prospective databases used for all robotic procedures at the respective institution and an additional review of computerized patient files was performed. Reproductive outcome evaluation was restricted to women with ≥12months follow-up and an active wish to conceive. Oncological outcome was evaluated for all patients. ResultsFifty-six women (3 stage IA1, 14 stage IA2 and 39 stage IB1) were included. The median age was 29years (range 23–41). Median follow-up was 24months (range 1–89). Seven trachelectomies were aborted in favor of a radical hysterectomy and/or chemoradiation due to nodal metastases or insufficient margins; two distant recurrences occurred in these women. A local recurrence was seen in two of the 49 women (4%) in whom the procedure was completed as planned. Seventeen of the 21 women (81%) in the reproductive follow-up group conceived - 16 naturally and one following IVF. Sixteen women (94%) delivered in the third trimester, 12 women (71%) in gestational week ≥36. One (6%) second trimester delivery occurred. ConclusionThe high fertility rate, low rate of premature deliveries and an acceptable rate of recurrence support the feasibility of robotic fertility-sparing radical trachelectomy in women with early stage cervical cancer.

Surgical and obstetrical outcomes after laparoscopic radical trachelectomy and pelvic lymphadenectomy for early cervical cancer.

ObjectiveThe aim of this study was to evaluate the surgical and obstetrical outcomes of patients with early cervical cancer who underwent laparoscopic radical trachelectomy and pelvic lymphadenectomy.MethodsWe analyzed data from women who underwent laparoscopic radical trachelectomy and pelvic lymphadenectomy between July 2000 and October 2014.ResultsOf a total of 12 patients, 91.7% were FIGO (International Federation of Gynecology and Obstetrics) stages IA2 and IB1. Seven patients (58.3%) had squamous cell carcinoma. The median tumor size was 1.87 cm (range, focal to 4.6 cm) and two patients (16.7%) had a tumor lager than 2 cm. Lymphovascular space invasion in the tumor lesion was reported in six patients (50%). The following surgical complications were observed: neurogenic bladder (one patient), hemoperitoneum (one patient), and infection (one patient). A total of 33.3% had attempted to conceive, resulting in two pregnancies and two healthy babies. All pregnancies were achieved by in vitro fertilization and embryo transfer. Each woman underwent cesarean delivery because of premature pre-labor rupture of membranes at gestational weeks 27.3 and 33.3. After a median follow-up time of 4.4 years (range, 1 to 8 years), there were no recurrences or deaths.ConclusionLaparoscopic radical trachelectomy and pelvic lymphadenectomy should be offered as an alternative treatment for women with early stage cervical cancer who want to preserve their fertility.

Laparoscopic Vaginal-Assisted Nerve-Sparing Radical Trachelectomy

Study ObjectiveTo demonstrate a laparoscopic vaginal-assisted nerve-sparing radical trachelectomy. DesignAn edited educational video, including a step-by-step description of the procedure. SettingRadical trachelectomy is the main surgical indication for selected cases of initial cervical cancer with a fertility-sparing approach. Although transvaginal access is the most traditional route, this technique has not gained widespread acceptance because of the complexity of the ureteral dissection and the limited amount of resected parametrial tissue. This video describes a laparoscopic technique including an adequate parametrial resection with autonomic preservation (C1 level) and a standard laparoscopic ureteric dissection under direct visualization. All parametrial dissections were performed by laparoscopy using a nerve-sparing technique. The uterine vessels were well dissected and transected at their origin. The colpotomy was performed by laparoscopy with a 1-cm vaginal margin using a monopolar energy hook. To achieve an adequate endocervical margin and to avoid thermal injury to the endocervix, the cervical section was performed transvaginally with a cold knife. The specimen was then retrieved, and a segment of the remaining cervix was removed for frozen section analysis. If the margin was free of tumor, the cervical-vaginal anastomosis was performed transvaginally. An endocervical device was placed to avoid postoperative cervical stenosis. InterventionsLaparoscopic vaginal-assisted nerve-sparing radical trachelectomy. ConclusionThis video demonstrates a reproducible laparoscopic technique for radical trachelectomy with a nerve-sparing technique. The vaginal route was used at the moment of sectioning the cervix/isthmus to permit adequate margin evaluation.

Laparoscopic Radical Trachelectomy in a Young Patient With Early Cervical Cancer

Laparoscopic Radical Trachelectomy in a Young Patient With Early Cervical Cancer

Perioperative Outcomes of Radical Trachelectomy in Early-Stage Cervical Cancer: Vaginal Versus Laparoscopic Approaches

This study aimed to compare the laparoscopic-assisted radical vaginal trachelectomy (LARVT) and laparoscopic radical trachelectomy (LRT) surgical approaches and provide outcome data on patients who have undergone radical trachelectomy. We identified patients who had undergone LARVT or LRT at Samsung Medical Center between January 2005 and March 2013. A total of 38 patients were identified, and 21 patients had undergone LARVT, whereas 17 patients had undergone LRT. The median age was 32 years for both groups. Most of the patients had a squamous cell carcinoma (68.4%) and International Federation of Gynecology and Obstetrics stage IB1 disease (76.3%). Twenty (52.6%) of 38 patients had tumor size greater than 2 cm. There were no significant differences between groups in the baseline characteristics except for the tumor size. Patients undergoing LRT had significantly larger tumor size than patients undergoing LARVT (median tumor size, 2.7 cm [range, 1.2-3.7] vs 2.1 cm [range, 0.4-3.0], P = 0.032). Perioperative outcomes were similar between groups except for the decline of hemoglobin after surgery. The median decline of hemoglobin indicating blood loss was significantly smaller in the LRT group than in the LARVT group (1.8 g/dL [range, 0.5-3.5] vs 2.6 g/dL [range, 0.7-6.2], P = 0.017). Intraoperative complications occurred in 2 patients (9.5%, 2/21) in LARVT group. Although 52.6% of tumors were larger than 2 cm, recurrence occurred only in 3 (7.9%) patients who underwent LARVT. The study shows the feasibility of LRT, with the advantage of reduced blood loss. The LRT could be an alternative option for patients with large tumors. Further researches are needed to investigate the long-term outcomes.

Laparoscopic radical trachelectomy: technique, feasibility, and outcomes.

Background and Objectives:Our objectives are to describe our surgical technique for laparoscopic radical trachelectomy, to evaluate its feasibility, and to present the perioperative results at Hospital Italiano de Buenos Aires, Argentina.Methods:We analyzed 4 patients who underwent laparoscopic radical trachelectomy for early-stage cervical cancer between December 2011 and May 2013.Results:Four patients were included in this study. Total laparoscopic radical trachelectomy was performed in all cases. The mean age was 26 years (range, 19–32 years), the mean body mass index was 21 (range, 18–23), and the mean length of hospital stay was 33 hours (range, 24–36 hours). The mean operative time was 225 minutes (range, 210–240 minutes), and no complications were reported. During the postoperative period, only 1 patient presented with left vulvar edema, which resolved spontaneously. The pelvic and parametrial lymph nodes, as well as the vaginal cuff and cervical resection margins, were negative for malignancy in all cases. On average, 18 pelvic lymph nodes (range, 15–20) were removed. The tumor stage was IB in all 4 patients, and the mean tumor size was 17 mm (range, 12–31 mm). No patient required conversion to laparotomy.Conclusion:We consider laparoscopic radical trachelectomy, performed by trained surgeons, a feasible and safe therapeutic option as a fertility-sparing surgical technique, with good perioperative outcomes for women with early-stage cervical cancer with a desire to preserve their fertility. Minimally invasive surgery provides the widely known benefits of this type of approach.

Laparoscopic Radical Trachelectomy in a Pregnant Patient with Invasive Cervical Cancer at the Second Trimester

This video is to show the first case of laparoscopic radical trachelectomy in a young pregnant patient with cervical cancer FIGO stage IB1 at the second trimester. During the procedure, pelvic lymph nodes were removed completely and sent for frozen section. The result was reported as negative. Then the excised cervix was removed and sent for frozen section. After a negative endocervical margin was confirmed on frozen section, the cervical stump were closed and the upper vagina sutured. It took us about 6 hours to finish the procedure, no intraoperative complications occurred and blood loss was 400ml.