Robotic Radical Trachelectomy Research Articles

Surgical procedures and techniques in robot-assisted uterine artery-preserving radical trachelectomy.

The aim of the study was to study robotic cervical radical trachelectomy, aimed at standardizing and optimizing surgical procedures, thereby facilitating the learning process. All surgical procedures were based on the anatomy of the embryonic compartments, which not only help prevent tumor spillage due to disruption of the embryonic compartments, but also maximize the avoidance of inadequate resection margins. Using robotics to perform radical trachelectomy, combined with the concept of membrane anatomy, not only enables a bloodless surgical process, but also streamlines and simplifies the procedure, making it more efficient and precise. Utilizing robotics for radical hysterectomy can lead to a more meticulous and refined outcome. Precise surgical techniques contribute to standardizing and optimizing surgical procedures, thereby facilitating the learning process.

Surgical, oncologic, and obstetric outcomes of radical trachelectomy in early-stage cervical cancer: results from a retrospective cohort study at Brazil National Cancer Institute.

to analyze oncological, obstetrical, and surgical results of young early-stage cervical cancer patients who underwent radical trachelectomy (RT) surgery and wished to maintain their fertility. a retrospective cohort study was carried out concerning cases attended at the Brazilian National Cancer Institute Gynecology Oncology Service. Patients who underwent RT between January 2005 and January 2021 were included. A total of 32 patients with median age of 32 years old, 62.5% of whom were nulliparous, were assessed. Concerning cancer type, 65.6% squamous cell carcinoma (SCC) cases, 31.2% adenocarcinoma cases and 3.1% adenosquamous carcinoma cases were verified. Stage IA2 was evidenced in 12.5% of the patients and stage IB < 4cm in 87.5%. Regarding surgical approaches, 68.25% of the patients underwent vaginal RT (VRT), 18.75%, abdominal RT (ART), 9.3%, the robotic radical trachelectomy (RORT) and 3.1%, video laparoscopy radical trachelectomy (VLRT). The median number of removed lymph nodes was 14, with only two detected as positive. Two cases of positive surgical margins were noted. A total of 3.1% intraoperative and 31.25% postoperative complications were observed, with cervical stenosis being the most common. The recurrence rate of the study was 3.1%, with a median follow-up time of 87 months, where 3.1% deaths occurred. The pregnancy rate of the study was 17.85% (5/28), with 54.5% evolving to live births and 45.5% evolving to abortion. Radical trachelectomy is a feasible procedure presenting good oncological results and acceptable pregnancy rates.

Laparoscopic Hysterectomy Following Robotic Radical Trachelectomy

<h3>Study Objective</h3> To demonstrate safe laparoscopic technique in performing hysterectomy following a previous radical trachelectomy. <h3>Design</h3> Stepwise demonstration using narrated video footage. <h3>Setting</h3> An academic safety net county hospital. <h3>Patients or Participants</h3> A 38-yo G5P0050 with a history of Stage 1B1 squamous cell carcinoma of the cervix was treated with robotic radical trachelectomy in 2011. She represented ten years later with abnormal uterine bleeding from a large prolapsing fibroid requiring multiple blood transfusions. Patient desires to proceed with definitive surgical management and underwent laparoscopic hysterectomy, bilateral salpingectomy, and cystoscopy. <h3>Interventions</h3> In certain cases of cervical cancer, patients can be offered fertility sparing options such as trachelectomy. Following radical dissection of the parametria, pelvic anatomy becomes distorted due to the development of fibrotic tissue. Additionally, following a trachelectomy a colpotomizer cup cannot be used to help lateralize and protect the ureters from inadvertent injury. Therefore, a completion hysterectomy has an elevated risk of urologic injury. We demonstrate a surgical technique to perform a completion hysterectomy laparoscopically. 1. Ureteral stent placement aids in identification of the ureters in the previously dissected surgical field. 2. Identification of pelvic anatomy and restoring normal anatomy is vital in performing a completion hysterectomy laparoscopically. <h3>Measurements and Main Results</h3> The patient underwent a laparoscopic hysterectomy, bilateral salpingectomy, bilateral ureterolysis, and cystoscopy without intraoperative complications. Her postoperative course was uncomplicated and had no further complaints at her six-week postoperative visit. <h3>Conclusion</h3> This case demonstrates a surgical technique to perform a laparoscopic hysterectomy following a robotic radical trachelectomy.

Single Port Robotic Hysterectomy after the Previous Robotic Radical Trachelectomy

<h3>Study Objective</h3> The basic treatment for cervix cancer is hysterectomy. For nullipara women, trachelectomy may be considered. In this video, we described the technique of a single port robotic hysterectomy to a patient who underwent a multi-port robotic radical trachelectomy previously. <h3>Design</h3> Case Report. <h3>Setting</h3> Academic medical center. <h3>Patients or Participants</h3> This 32-year-old woman presented with a recurrence of cervical cancer. She had a history of robotic radical trachelectomy with pelvic lymphadenectomy for stage IA1 cervical cancer 9 years earlier. <h3>Interventions</h3> At first, we described the typical multi-port robotic radical trachelectomy which preserved the main uterine artery and round ligament. There was no recurrence in follow up MRI and colposcopy after the surgery. But in December 2021, her pap-smear revealed adenocarcinoma. MRI of the pelvis and PET CT were all normal. After careful consideration, our team used DaVinci SP system to perform the hysterectomy and BS. The operation was similar to a general hysterectomy, but there was an adhesion between the uterus and the ovary due to the previous operation. Although several branches of the uterine artery were ligated, the blood supply to the uterus was sufficient. The uterus and bladder also had moderate adhesion. After the colpotomy, the thread of cervical cerclage in the previous operation was confirmed. The subsequent procedure was similar to that of a typical hysterectomy. <h3>Measurements and Main Results</h3> The operation was performed successfully with no intraoperative complications. <h3>Conclusion</h3> Single port robotic hysterectomy after the previous robotic trachelectomy is a safe and effective approach for the recurrence of cervical cancer patients. There was some difficulty in finding the incision margin between the uterus ithmus and the upper vagina. The bladder and vagina fornix should be carefully dissected. The secondary assistant should push the colpotomizer in the same direction as the incision. Single port Robotics can help to overcome the limitations of laparoscopy, especially in complicated procedures.

Robotic versus vaginal radical trachelectomy for reproductive-aged women with early cervical cancer: a multi-center Canadian study (097)

Robotic versus vaginal radical trachelectomy for reproductive-aged women with early cervical cancer: a multi-center Canadian study (097)

Neoadjuvant chemotherapy with quick cisplatin-VP 16 followed by robotic radical trachelectomy in FIGO 2018 stage 1B2 cervical cancer

Background: The typical treatment of the International Federation of Gynecology and Obstetrics 2018 stage IB2 cervical cancer is radical hysterectomy. With the trend of delayed childbearing, the importance of fertility sparing in the treatment of women with cervical cancer has drawn attention. Case: We report a case of stage IB2 cervical cancer treated by neoadjuvant chemotherapy with quick cisplatin-VP 16 followed by robotic radical trachelectomy. Conclusions: Neoadjuvant chemotherapy (NACT) using platinum-based therapy with cisplatin and trachelectomy performed through the vagina or abdominal approach was used in most previous cases. We successfully performed NACT with quick cisplatin-VP 16, followed by robotic radical trachelectomy in stage 1B2 cervical cancer. Further studies are needed to accumulate cases and outcomes of fertility-preserving treatment techniques.

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.

Resection of the upper paracervical lymphovascular tissue should be an integral part of a pelvic sentinel lymph node algorithm in early stage cervical cancer

ObjectiveTo investigate the prevalence of lymph nodes and lymph node metastases (LNMs) in the upper paracervical lymphovascular tissue (UPLT) in early stage cervical cancer. MethodsIn this prospective study consecutive women with stage IA1-IB1 cervical cancer underwent a pelvic lymphadenectomy including identification of sentinel nodes (SLNs) as part of a nodal staging procedure in conjunction with a robotic radical hysterectomy (RRH) or robotic radical trachelectomy (RRT). Indocyanine green (ICG) was used as tracer. The UPLT was separately removed and defined as “SLN-parametrium” and, as all SLN tissue, subjected to ultrastaging and immunohistochemistry. Primary endpoint was prevalence of lymph nodes and metastatic lymph nodes in the UPLT. Secondary endpoints were complications associated with removal of the UPLT. ResultsOne hundred and forty-five women were analysed. Nineteen (13.1%) had pelvic LNMs, all identified by at least one metastatic SLN. In 76 women (52.4%) at least one UPLT lymph node was identified. Metastatic UPLT lymph nodes were identified in six women of which in three women (2.1% of all women and 15.8% of node positive women) without lateral pelvic LNMs. Thirteen women had lateral pelvic SLN LNMs with either no (n = 5) or benign (n = 8) UPLT lymph nodes. No intraoperative complications occurred due to the removal of the UPLT. ConclusionRemoval of the UPLT should be an integral part of the SLN concept in early stage cervical cancer.

Open vs minimally invasive radical trachelectomy in early-stage cervical cancer: International Radical Trachelectomy Assessment Study

Minimally invasive radical trachelectomy has emerged as an alternative to open radical hysterectomy for patients with early-stage cervical cancer desiring future fertility. Recent data suggest worse oncologic outcomes after minimally invasive radical hysterectomy than after open radical hysterectomy in stage I cervical cancer. We aimed to compare 4.5-year disease-free survival after open vs minimally invasive radical trachelectomy. This was a collaborative, international retrospective study (International Radical Trachelectomy Assessment Study) of patients treated during 2005-2017 at 18 centers in 12 countries. Eligible patients had squamous carcinoma, adenocarcinoma, or adenosquamous carcinoma; had a preoperative tumor size of ≤2 cm; and underwent open or minimally invasive (robotic or laparoscopic) radical trachelectomy with nodal assessment (pelvic lymphadenectomy and/or sentinel lymph node biopsy). The exclusion criteria included neoadjuvant chemotherapy or preoperative pelvic radiotherapy, previous lymphadenectomy or pelvic retroperitoneal surgery, pregnancy, stage IA1 disease with lymphovascular space invasion, aborted trachelectomy (conversion to radical hysterectomy), or vaginal approach. Surgical approach, indication, and adjuvant therapy regimen were at the discretion of the treating institution. A total of 715 patients were entered into the study database. However, 69 patients were excluded, leaving 646 in the analysis. Endpoints were the 4.5-year disease-free survival rate (primary), 4.5-year overall survival rate (secondary), and recurrence rate (secondary). Kaplan-Meier methods were used to estimate disease-free survival and overall survival. A post hoc weighted analysis was performed, comparing the recurrence rates between surgical approaches, with open surgery being considered as standard and minimally invasive surgery as experimental. Of 646 patients, 358 underwent open surgery, and 288 underwent minimally invasive surgery. The median (range) patient age was 32 (20-42) years for open surgery vs 31 (18-45) years for minimally invasive surgery (P=.11). Median (range) pathologic tumor size was 15 (0-31) mm for open surgery and 12 (0.8-40) mm for minimally invasive surgery (P=.33). The rates of pelvic nodal involvement were 5.3% (19 of 358 patients) for open surgery and 4.9% (14 of 288 patients) for minimally invasive surgery (P=.81). Median (range) follow-up time was 5.5 (0.20-16.70) years for open surgery and 3.1 years (0.02-11.10) years for minimally invasive surgery (P<.001). At 4.5 years, 17 of 358 patients (4.7%) with open surgery and 18 of 288 patients (6.2%) with minimally invasive surgery had recurrence (P=.40). The 4.5-year disease-free survival rates were 94.3% (95% confidence interval, 91.6-97.0) for open surgery and 91.5% (95% confidence interval, 87.6-95.6) for minimally invasive surgery (log-rank P=.37). Post hoc propensity score analysis of recurrence risk showed no difference between surgical approaches (P=.42). At 4.5 years, there were 6 disease-related deaths (open surgery, 3; minimally invasive surgery, 3) (log-rank P=.49). The 4.5-year overall survival rates were 99.2% (95% confidence interval, 97.6-99.7) for open surgery and 99.0% (95% confidence interval, 79.0-99.8) for minimally invasive surgery. The 4.5-year disease-free survival rates did not differ between open radical trachelectomy and minimally invasive radical trachelectomy. However, recurrence rates in each group were low. Ongoing prospective studies of conservative management of early-stage cervical cancer may help guide future management.

A combination of second trimester oral metronidazole and no sexual intercourse during second and third trimester may reduce late miscarriage and premature delivery after fertility sparing radical trachelectomy

ObjectivesWomen with a previous trachelectomy have an increased risk of premature delivery and second trimester miscarriage. In this study we aim to evaluate factors and regimes possibly affecting the risk for prematurity following fertility sparing robotic radical trachelectomy (RRT) in cervical cancer. MethodsA retrospective study of the reproductive outcome following RRT with a cervical cerclage performed at one of four academic centers between 2007 and 2019. Factors possibly related to premature delivery, such as postoperative non-pregnant cervical length, previous vaginal deliveries, preservation of the uterine arteries, and the use of a second trimester oral metronidazole/no sexual intercourse regime, were assessed. Results109 women remained for analyses after excluding recurrences before pregnancy (n = 8), secondary hysterectomy (n = 2), and women with less than six months follow up (n = 10). 74 pregnancies occurred in 52/71 women attempting to conceive, 56 of which developed past the first trimester. Two of 22 women (9%) who were prescribed an oral metronidazole regime (400 mg × 2 from gestational week 15 + 0 to 21 + 6 and abstaining from sexual intercourse for the duration of the pregnancy) had a premature delivery, compared with 13/31 (42%) where the regime was not applied (p = 0.009). The association remained after regression analyses including possible contributing factors as of above, none of which associated with prematurity at regression analyses (p = 0.001). ConclusionsThe observed four-fold reduction in premature delivery indicates that an oral metronidazole/no sexual intercourse regime may reduce second trimester miscarriage and premature deliveries following an RRT. No association was observed for other investigated factors.

15 Robotic radical trachelectomy with abdominally placed vaginal cerclage

15 Robotic radical trachelectomy with abdominally placed vaginal cerclage

Robotic Radical Trachelectomy Using the Double Bipolar Method- Aiming for a Bloodless Operative Field

Study ObjectiveTo report the application of the double bipolar technique in a patient with 1b1 cervical cancer who wished to preserve her fertility potential.DesignAfter experiencing 105 cases of laparoscopic and robotic radical trachelectomy with a 5 year survival rate of 98% and the birth of 29 babies from 51 of these patients who attempted pregnancy, we introduced the double bipolar method to overcome technical difficulties of the procedure due to the necessity for precise dissection and reconstruction in the deep pelvis. We will show our operative techniques, such as nerve sparing radical trachelectomy and retroperitoneal lymphadenectomy for early invasive cervical cancer in a bloodless operative field.SettingUrban general hospital.Patients or ParticipantsRobotic radical trachelectomy using the double bipolar method was performed in three patients with 1b1 cervical cancer.InterventionsAfter Robotic radical trachelectomy using monopolar scissors in 30 cases of stage Ib1 cervical cancer, we considered techniques for a more bloodless operative field. The double bipolar method (DBM) was originated by a robotic gastrointestinal surgeon, Prof Ichiro Uyama. Using robotic Maryland forceps as a cutting device allows for pinpoint accuracy that cannot be found in other instruments. It is important for bladder and ureteral dissection and exposure of vessels. Cuts are made at a very limited point by a lightning strike mechanism, meaning there is minimal thermal spread to adjacent organs.Measurements and Main ResultsBlood loss was 250ml in the cases presented. In surgeries not using the DBM(n=34), the blood loss ranged from 350ml(100-1200ml). While there is no supporting data, the dissection of the ureter was very smooth.ConclusionA bloodless operative field allows for accurate dissection and can prevent intraoperative injuries. The double bipolar method is able to provide precision cutting and limit thermal spread to adjacent tissue, reducing injury and allowing for a clear operative field.

Robotic Radical Trachelectomy with an Abdominally Placed Vaginal Cerclage

Study Objective To demonstrate a robotic radical trachelectomy where-in a vaginal purse-string suture was placed abdominally in order to contain the cervical tumor. Design A case report. Setting A tertiary referral center. Patients or Participants A 32-year-old gravida 0 presented with stage IB1 squamous cell carcinoma of the cervix. Pelvic MRI demonstrated a tumor the size of 1.5cm where the upper margin of the lesion was >2 cm from the uterine isthmus. PET/CT was without evidence of metastatic disease. Interventions The patient desired future fertility and opted for a robotic radical trachelectomy. The patient was placed in dorsal lithotomy position. No intrauterine manipulator was placed. ICG dye was injected onto cervix for delineation of pelvic sentinel lymph nodes. Bilateral pararectal, paravesical, and obturator spaces were developed after which bilateral pelvic sentinel lymph nodes were removed with negative frozen results. The uterine arteries were skeletonized and separated from their ureteral attachments. The rectovaginal and vesicovaginal spaces were developed. The bilateral paracervix were transected off. 2-0 prolene suture was utilized to place a purse-string suture onto upper vagina. The colpotomy was then performed circumferentially and cervix was amputated about 1 cm below the uterine isthmus. Trachelectomy specimen margins were negative. The upper vagina was then reconstructed to the lower uterine segment. A pediatric foley was placed into the lower uterine segment to minimize the risk of cervical stenosis. Measurements and Main Results Robotic radical trachelectomy was performed without any complications, where-in a uterine manipulator was avoided and a purse-string suture was placed onto upper vagina to minimize tumor manipulation and prevent spillage into peritoneal cavity, respectively. Conclusion We believe that if MIS surgeons adhere to basic oncologic surgical principles, we will be able to provide our patients with proven MIS benefits without compromising oncological safety.

An Australian, single-centre study of surgical management outcomes for early-stage cervical cancer.

The Laparoscopic Approach to Cervical Cancer (LACC) trial is the first phase III randomised, multicentred trial to compare oncologic outcomes associated with open radical hysterectomy vs minimally invasive surgery (MIS) for treatment of early cervical cancer. To evaluate our surgical experience in patients with early cervical cancer. The Lifehouse Gynaecologic Oncology database was queried based upon the eligibility criteria of the LACC study and included all FIGO 2009 stage (1A1 with lymph vascular space invasion, 1A2, 1B1) cervical cancer women from 2008-2018. Patients were also included in our study if they had abdominal radical trachelectomy (ART), laparoscopic radical hysterectomy (TLRH) and robotic radical trachelectomy (RRT). Forty-six women were identified with four exclusions. Thirty-seven women had stage 1B1 disease, 24 had a squamous cell carcinoma, 15 had an adenocarcinoma and three had an adenosquamous carcinoma of the cervix. Of the 42 eligible patients, 32 underwent an open abdominal approach (26 total abdominal radical hysterectomy (TARH), six ART) and ten a MIS approach (nine TLRH and one RRT) with a mean follow-up of 4.8years. All 42 women had a pelvic lymph node dissection, eight women had nodal metastases and 16 patients received adjuvant chemoradiation. Two of the nine women in the laparoscopic radical hysterectomy group had a recurrence. Both had adenocarcinoma, stage 1B1 disease. There were no recurrences in the TARH group or radical trachelectomy groups. Our data, albeit limited in number, have reflected the results of the LACC trial that MIS was associated with a lower disease-free survival than open radical hysterectomy.

05: Retroperitoneal anatomy and parametrial dissection in robotic uterine-artery sparing radical trachelectomy

To review retroperitoneal and parametrial anatomy, demonstrate surgical techniques for retroperitoneal and parametrial dissection, and describe obstetric outcomes of uterine artery-sparing radical trachelectomy. A 29-year old with stage 1B1 adenosquamous carcinoma of the cervix underwent uterine artery-sparing robotic-assisted radical trachelectomy, upper vaginectomy, excision of bilateral pelvic sentinel lymph nodes, excision of left internal iliac node, and cerclage placement. The parametrial dissection was performed with robotic assistance, while the colpotomy, trachelectomy, and cerclage were performed transvaginally to minimize contamination to the peritoneal cavity. Minimally-invasive trachelectomy has benefits of decreased blood loss and less recovery time, and attempts to spare the uterine artery should be considered in patients desiring fertility preservation.

Combining Indocyanine Green and Tc99-nanocolloid does not increase the detection rate of sentinel lymph nodes in early stage cervical cancer compared to Indocyanine Green alone

ObjectiveTo investigate whether combining two independent tracers increases the SLN-detection rate in cervical cancer. MethodsConsecutive women with early stage cervical cancer planned for a robotic radical hysterectomy or a robotic radical trachelectomy with sentinel lymph node (SLN) detection were included. After cervical injections of Indocyanine green (ICG) and Tc99-nanocolloid (Tc99), near-infrared fluorescence imaging and a gamma probe were used to identify SLNs in the upper and lower paracervical pathways (UPP/LPP). A strict surgical algorithm was adhered to and the SLNs were defined as SLN-ICG, SLN-ICG+Tc99 or SLN-Tc99. In FIGO-stage ≥IA2 cancers a full pelvic lymph node dissection (PLND) was performed after detection of SLNs. The primary endpoint was the SLN detection rate per tracer and combination of tracers. Secondary endpoints were sensitivity and mapping rates of the SLN algorithm per tracer and combination of tracers. ResultsIn the sixty-five analyzed women, the bilateral mapping rate was 98.5% for ICG and 60% for Tc99 (p < 0.01). Combining the tracers did not increase the bilateral detection rate. In three women (5%) Tc99 identified ICG-negative non-metastatic SLNs without impact on the bilateral detection rate. Eight women (12%) had lymph node metastases (LNMs), all had at least one metastatic SLN. Seven (35%) of the 20 metastatic SLNs were detected by ICG only and 12 (60%) were ICG and Tc99 positive. ConclusionSLN detection rate was significantly higher using ICG compared with Tc99. ICG identified all patients with LNMs. Combining ICG and Tc99 did not improve the bilateral detection rate of SLNs.

1879 Comparison of MRI, PET-CT, and Frozen Biopsy in The Evaluation of Lymph Node Status Before Fertility-Sparing Robotic or Laparoscopic Radical Trachelectomy in Early Stage Cervical Cancer

Study Objective To compare the accuracy of MRI, PET-CT, and frozen biopsy before fertility-sparing radical trachelectomy in early stage cervical cancer. Design This was a retrospective study on 134 young women with early stage cervical cancer who tried fertility-sparing laparoscopic or robotic radical trachelectomy. All patients underwent preoperative MRI and PET-CT. Comprehensive lymph node dissection was performed during surgery. Retrieved lymph nodes were sent for frozen biopsy before undertaking radical trachelectomy. The diagnostic accuracy of MRI, PET-CT, and frozen biopsy was compared using McNemar test and logistic regression using generalized estimating equations. The final pathologic report on lymph nodes was the gold standard for diagnosis. Setting University hospital. Patients or Participants 134 patients with early stage cervical cancer. Interventions Fertility-sparing, robotic or laparoscopic radical trachelectomy. Measurements and Main Results The retrieved lymph nodes totaled 3362 and mean of retrieved lymph nodes was 25 (range 7- 96). Twenty patients (14.9%) showed positive lymph node areas and 39 out of 986 (4.0%) lymph nodes areas were positive. There was no significant difference in sensitivity (22.6% versus 31.0%, p>0.99), specificity (94.3% versus 95.3%, p=0.83), and accuracy (90.8% versus 92.3%, p=0.5) between MRI and PET-CT in station-by-station analysis. There was significant difference in sensitivity, specificity, accuracy between MRI and frozen biopsy in station-by-station analysis. There was also a significant difference between PET-CT and frozen biopsy. Conclusion When comparing patients with patients, frozen biopsy approach is significantly better than MRI and PET-CT to evaluate sensitivity, specificity, and accuracy. Frozen biopsy of all lymph nodes retrieved during surgery is still the best method to evaluate lymph node status before fertility-sparing radical trachelectomy.

Our ideas and devices to establish stable and precise procedures in robotic radical trachelectomy for cervical cancer patients

Objective: To preserve fertility of cervical cancer patients, we started abdominal radical trachelectomy (ART) in 2005 and accomplished successful surgical outcome with only 1 recurrence in almost 200 cases slightly including abdominal modified-radical or simple trachelectomy. With almost 40% of patients who attempted to conceive after their abdominal trachelectomies, almost 40% of them became pregnant. However, many cases needed artificial insemination by husband or artificial reproductive technology to be pregnant. Therefore, we started to shift ART to robotic RT (RRT), which may bring not only minimal invasiveness but also increased spontaneous pregnancy rate due to reducing postoperative adhesion.

Robotic radical trachelectomy with sentinel lymph node mapping using ICG in early cervical cancer – a brief report

Robotic radical trachelectomy with sentinel lymph node mapping using ICG in early cervical cancer – a brief report

722 - Vaginal Approach (Colpotomy and Tumor Extraction) in Robotic Radical Hysterectomy Should be a Preferred Method in Cervical Cancer: A Study of 31 Cases

Objective: To evaluate the recurrence rate and pattern of patients with cervical cancer who had underwent robotic radical hysterectomy through vaginal colpotomy (RRH-V) or robotic radical trachelectomy through vaginal colpotomy (RRT-V). And, other surgical and oncological outcomes were also evaluated.