Laparoscopic Radical Trachelectomy Research Articles

326: Completely Total Laparoscopic Radical Trachelectomy

326: Completely Total Laparoscopic Radical Trachelectomy

Laparoscopic abdominal radical trachelectomy

Background Radical trachelectomy is a fertility preserving alternative for young women with early stages of cervical cancer. Currently, a technique of abdominal radical approach is used in a few centres. With growing availability of laparoscopy, a novel technique of laparoscopic radical trachelectomy might be an alternative. Case Presented is one case of laparoscopic pelvic lymphadenectomy with radical trachelectomy in young woman with IB cervical cancer. No intraoperative or postoperative complications occurred. Operation time reached 250 min, estimated blood loss was 250 ml. Limited follow-up of 9 months was uneventful and patient indicates normal menstrual pattern and satisfactory sexual intercourse. Conclusion Laparoscopic abdominal radical trachelectomy with pelvic lymphadenectomy might be an alternative technique in the treatment of early stages cervical cancer in patients who desire future pregnancy. The procedure is in principle identical to the standard abdominal radical hysterectomy. Centres practising laparoscopic radical hystertectomy can adopt the technique without any special surgical training.

Laparoscopic Radical Trachelectomy for Stage Ib1 Cervical Cancer

Radical trachelectomy by vaginal approach is an alternative for young women with early-stage cervical cancer. We modified this procedure to treat two patients with stage Ib1 cervical cancer. With 100% laparoscopic pelvic lymphadenectomy and 80% laparoscopic approach, the technique is laparoscopic radical trachelectomy (LRT). Under direct enhanced vision of the laparoscope, it is easy to identify and preserve ascending branches of the uterine arteries and to divide ligaments surrounding the cervix and vagina. Vaginal procedures require only colpotomy, amputation of cervix, dividing caudal paracolpium, and corpus-vagina anastomosis. Short-term follow-up results of our first patients are satisfactory. Thus, LRT could be a useful alternative for women with early cervical cancer who want to preserve fertility.

Abordaje laparoscópico en la cirugía radical conservadora del cáncer invasivo de cérvix en pacientes jóvenes. Experiencia preliminar

ObjectiveThe purpose of this study was to evaluate, in a preliminary way, the role of a new surgical approach of fertility-preserving surgery in young patients with early invasive cervical cancer (radical trachelectomy) Patients And MethodsThe first three cases scheduled for laparoscopic vaginal radical trachelectomy corresponding to patients with 35, 36 and 39 years old and FIGO IB1 invasive cervical cancer. Patients were informed of the experimental character of the technique and a fully informed consent was obtained. Vaginal approach was facilitated by laparoscopic preparation of anatomical spaces (paravesical and pararectal) and radical division of cardinal and uterosacral ligaments. The arterial irrigation of uterine corpus was preserved ResultsLaparoscopic approach was carried out in all the cases with a mean operative time of 3 h and 10 min. In the first two cases the results of frozen sections allowed to carry out the radical trachelectomy without incidences. Both surgical speciments presented safe negative margins and a mean of 18 pelvic nodes. In the third case a radical vaginal hysterectomy was performed due to find a metastasis in one pelvic node. Two postoperative complications were registered: an pelvic infection that required vaginal drainage and a laparoscopic incisional hernia that required surgical repair. Actually the two patients treated with a conservative surgical approach carry out oral birthcontrol treatment, presenting regular menstruations and negative control of vaginal cytologies ConclusionsLaparoscopic approach, including division of cardinal and uterosacral ligaments, allows to preserve the arterial irrigation of the uterus and to provide a better vaginal radical access