Ultra Minimally Invasive Two-Port Laparoscopic Trachelectomy without Uteteral Stents

Abstract

Study Objective
To design a laparoscopic technique to perform a safe laparoscopic trachelectomy in the safest, most minimally invasive, cost effective way possible, without the use of ureteral stents. Design: We designed a surgical technique based on keeping pressure pushed against the vaginal cuff deep within the abdomen to move the ureters laterally. We overcame the problem of keeping the cervix planted against the manipulator by the novel usage of a laparoscopic tenaculum used to hold the cervix from the vaginal approach (through the manipulator.)
Design
A narrated video demonstration of the surgical procedure (Canadian Task Force Classification III).
Setting
We developed a novel method for retaining the cervix at the apex of our manipulator while maintaining this pressure. The setting was a suburban hospital in the United States.
Interventions
The patient was an obese 46 year old female with pain in the area of the cervix and vaginal bleeding 10 years after open supra-cervical hysterectomy. Interventions: Two port laparoscopic trachelectomy without ureteral stents was performed. Our novel technique was successful in completing the procedure without complications. We have explained the technique and instrumentation in this video for reproducibility. The patient was discharged 26 hours after surgery and the recovery was uneventful.
Conclusion
Our described technique is a feasible, reproducible procedure for laparoscopic trachelectomy. Novel aspects of our technique may effectively eliminate the need for pre-operative ureteral stents in some cases.