Article

Uterine artery-preserving laparoscopic radical trachelectomy for early cervical cancer: Technical aspects

Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea.
Gynecologic Oncology (Impact Factor: 3.69). 05/2012; 126(2):277-8. DOI: 10.1016/j.ygyno.2012.04.039
Source: PubMed

ABSTRACT Radical trachelectomy is increasingly used for patients with early cervical cancer as an alternative to radical hysterectomy, who want to preserve their fertility [1]. Radical trachelectomy can be performed using minimal invasive techniques such as laparoscopy or robotics [2-4]. Laparoscopic radical trachelectomy (LRT) is generally classified into two types: total LRT of which all procedures are conducted via laparoscopy and laparoscopically-assisted vaginal radical trachelectomy (LAVRT) in which lymph node dissection and radical trachelectomy are performed via laparoscopy and vaginal route, respectively [3,4]. In the present surgical film, we introduce our LRT technique combining the foregoing types, which consists of 70% laparoscopic and 30% vaginal approaches. This technique was originally developed by one of the authors (JHN). LRT is usually performed after pelvic lymphadenectomy. This procedure leaves the paravesical and pararectal spaces widely open, the obturator fossa exposed down to the levator muscle, and the cardinal ligament isolated caudal to the uterine artery. The cardinal ligament is divided without ligation of the ascending branch of the uterine artery. The ureter is dissected from the peritoneum and mobilized with its adventitial tissue. The descending and ascending branches of the uterine artery were identified. The descending branch was divided and the ascending branch was mobilized up to the level of transaction of the cervix. After incising the vesicouterine and rectovaginal peritoneum, the vesicouterine and rectovaginal ligaments are divided. All these procedures are performed laparoscopically, and then the vaginal phase follows. The anterior and posterior colpotomy is made, the paracolpium is divided and the cervix is transected at the isthmic portion. The cervical cerclage is performed and the vagina and the uterus is reanatomosized. This technique seems to have some advantages - shorter time for reanastomosis compared to total LRT and more convenient and complete dissection of the ureter and parametrium compared to LAVRT. Moreover, the preservation of the uterine artery may be associated with more favorable restoration of the reproductive function (Fig. 1).

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