Uterine Artery Sparing Robotic Radical Trachelectomy and Pelvic Lymphadenectomy in Patients with Early-Stage Cervical Cancer

2010 ◽  
Vol 17 (6) ◽  
pp. S111
Author(s):  
G.O. Chong ◽  
N.Y. Park ◽  
D.G. Hong ◽  
Y.L. Cho ◽  
I.S. Park ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Uterine Artery ◽  
Early Stage ◽  
Pelvic Lymphadenectomy ◽  
Radical Trachelectomy ◽  
Early Stage Cervical Cancer

Robotic Uterine Artery Preservation and Nerve-Sparing Radical Trachelectomy With Bilateral Pelvic Lymphadenectomy in Early-Stage Cervical Cancer

2011 ◽  
Vol 21 (2) ◽  
pp. 391-396 ◽  
Author(s):  
Dae Gy Hong ◽  
Yoon Soon Lee ◽  
Nae Yoon Park ◽  
Gun Oh Chong ◽  
Il Soo Park ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Blood Loss ◽  
Uterine Artery ◽  
Early Stage ◽  
Pelvic Lymphadenectomy ◽  
Nerve Sparing ◽  
Radical Trachelectomy ◽  
Estimated Blood Loss ◽  
Early Stage Cervical Cancer ◽  
The Mean

Objective:The aim of the study was to evaluate the safety and feasibility of robotic uterine artery preservation and nerve-sparing radical trachelectomy with pelvic lymphadenectomy using the da Vinci surgical system.Methods:Three patients who were diagnosed with early-stage cervical cancer underwent robotic uterine artery preservation and nerve-sparing radical trachelectomy with bilateral lymphadenectomy from January 2010 to March 2010. The data were compared with those of 4 cases of total laparoscopic nerve-sparing radical trachelectomy that were performed from July 2004 to May 2005 and were previously reported.Results:In the robotic group, the mean console time was 275 minutes (range, 240-305 minutes). The mean postoperative hemoglobin change was 0.4 g/dL (range, 0.2-0.6 g/dL). The mean estimated blood loss was 23 mL (range, 15-40 mL), which is less than that of the laparoscopic group. There were no metastases detected in any of the cases, and the resection margins were negative in both groups.Conclusions:The robotic uterine artery preservation and nerve-sparing radical trachelectomy with pelvic lymphadenectomy were efficient in reducing blood loss and feasible methods such as other approaches.

scholarly journals Extraperitoneal radical trachelectomy with pelvic lymphadenectomy

2019 ◽  
Vol 29 (4) ◽  
pp. 842-842
Author(s):  
Kotaro Shimura ◽  
Seiji Mabuchi
Keyword(s):  
Cervical Cancer ◽  
Surgical Approach ◽  
Uterine Cervix ◽  
Early Stage ◽  
Foley Catheter ◽  
Pelvic Lymphadenectomy ◽  
Radical Trachelectomy ◽  
Uterosacral Ligaments ◽  
Early Stage Cervical Cancer ◽  
Umbilical Ligament

Radical trachelectomy combined with pelvic lymphadenectomy has been used to treat patients with early-stage cervical cancer who wish to preserve their fertility. Vaginal, abdominal, laparoscopic, and robotic approaches have been employed during this procedure, but all cause peritoneal damage, which could result in periadnexal adhesion. As periadnexal adhesion can lead to female infertility due to restricted sweeping of the fimbria over the ovary, it is important to minimize peritoneal damage during the fertility-preserving surgery. Aiming to minimize peritoneal damage, we recently developed a new surgical approach. The techniques used are similar to those used for type III radical hysterectomy; however, all procedures are performed via the extraperitoneal approach.In this video article, we describe a step-by-step technique of this new fertility-preserving surgical procedure. Surgical procedures are as follows: (1) extraperitoneal pelvic lymphadenectomy, (2) excision of the vesicohypogastric fascia and median umbilical ligament, (3) bladder dissection from the peritoneum and identification of uterine cervix, (4) transection of the cardinal ligaments and vesicouterine ligaments, (5) transection of the vagina, (6) excision of the rectovaginal and uterosacral ligaments, (7) transection of the uterine cervix, (8) cervical cerclage and placement of a Foley catheter, (9) anastomosis of the uterine cervix, (10) suture of the median umbilical ligament and vesicohypogastric fascia. During these procedures, the uterine arteries, inferior hypogastric nerve, and pelvic splanchnic nerve were preserved. The advantages of this new surgical approach are first, peritoneal injuries can be completely avoided as the procedure is performed extraperitoneally, and second, it can be carried out using conventional low-cost instruments. In view of these features, we consider that this technique could be an ideal treatment option for selected women with early-stage cervical cancer. The oncological and reproductive outcomes of this new surgical approach need to be evaluated in future clinical studies.

Intention-to-Treat Analysis of Radical Trachelectomy for Early-Stage Cervical Cancer With Special Reference to Oncologic Failures: Single-Institutional Experience in Hungary

2017 ◽  
Vol 27 (7) ◽  
pp. 1438-1445 ◽  
Author(s):  
Robert Póka ◽  
Szabolcs Molnár ◽  
Péter Daragó ◽  
János Lukács ◽  
Rudolf Lampé ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Pelvic Lymphadenectomy ◽  
Radical Trachelectomy ◽  
Eligibility Criteria ◽  
Prognostic Features ◽  
Early Stage Cervical Cancer ◽  
Oncologic Treatment

ObjectiveThe aim of our study was to evaluate clinical and pathological data in order to draw eligibility criteria for oncologically sufficient radical trachelectomy (RT) in early-stage cervical cancer. Reviewing all cases of attempted RT performed at our unit, we focused attention on prognostic indicators of the need for additional oncologic treatment following RT. The analysis was extended by extensive literature review to include previously published cases of oncologic failures.MethodsThe authors retrospectively analyzed data of patients who underwent RT at the Department of Obstetrics and Gynecology, University of Debrecen. Electronic records and case notes of RT cases were reviewed to determine the incidence of abdominal and vaginal route, distribution of clinicopathologic data, and follow-up results of individual cases. Individual procedures were categorized as oncologically insufficient if additional oncologic treatment was necessary following RT. Theoretical eligibility criteria for RT in early-stage cervical cancer were determined retrospectively by selecting prognostic features that were associated with oncologic insufficiency from clinicopathologic indicators of the complete series.ResultsTwenty-four cases of RT were performed by the authors, 15 vaginal RTs with laparoscopic pelvic lymphadenectomy and 9 abdominal RTs with open pelvic lymphadenectomy. Fifteen of 24 cases proved oncologically sufficient. Three cases required immediate conversion to radical hysterectomy because of positive sentinel nodes and/or positive isthmic disc on frozen section. In further 5 cases, final pathology results indicated additional oncologic treatment, that is, radical hysterectomy (n = 2), chemoradiotherapy (n = 2), or chemotherapy (n = 1). One patient among immediately converted cases and another 3 among those who required additional oncologic treatment died of their disease later. There were no other cases of recurrences over a median follow-up of 34 months (range, 12–188 months). Factors that may predict oncologic insufficiency of RT were stage IB1 or greater, tumor size of greater than 2 cm in 1 dimension or greater than 15 mm in 3 dimensions, G3, nonsquamous/adeno histological type, stromal invasion of greater than 9 mm, and lymphovascular space involvement in the primary tumor.ConclusionsMost cases of oncologically insufficient RTs have significant risk features that can be identified preoperatively. There is a need for more clinicopathologic data on oncologic failure of RT cases in order to improve patient selection.

scholarly journals Surgical, Oncological and Obstetric Outcomes After Radical Abdominal Trachelectomy for Early-Stage Cervical Cancer at a Single Tertiary Center.

2021 ◽  
Author(s):  
Marlene Kranawetter ◽  
Christoph Grimm ◽  
Helena M Obermair ◽  
Valentina Paspalj ◽  
Alexander Reinthaller ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Early Stage ◽  
Young Patients ◽  
Pelvic Lymphadenectomy ◽  
Resection Margins ◽  
Obstetric Outcomes ◽  
Safe Procedure ◽  
Radical Trachelectomy ◽  
Tertiary Center ◽  
Early Stage Cervical Cancer

Abstract Purpose Radical trachelectomy is a viable option to preserve fertility for young patients with early cervical cancer. The aim of this study was to report surgical, oncological and obstetric outcomes of patients treated with radical abdominal trachelectomy at our institution. Methods A retrospective chart analysis and telephone survey for all patients with early stage cervical cancer treated with a radical abdominal trachelectomy and pelvic lymphadenectomy between 2007 and 2019 at the Department of Obstetrics and Gynaecology at the Medical University of Vienna, Austria was performed. Results Radical abdominal trachelectomy with pelvic lymph-node dissection was attempted for 22 patients. Four cases required conversion to radical hysterectomy due to positive resection margins and two cases required primary chemo-radiotherapy due to positive lymph nodes. Sixteen successfully abdominal radical trachelectomies preserving fertility were performed with two of these patients treated with neo-adjuvant chemotherapy. With a median follow-up time of 21.5 (6.5- 57.25) months, one patient (4.5%) had disease recurrence and subsequently died from cervical cancer. Six patients attempted to conceive, with a resulting four pregnancies with a live birth rate of 75%. Conclusion Abdominal radical trachelectomy is a safe procedure for women with early stage cervical cancer who desire fertility preservation. Surgery should be performed at a high volume gynaeco-oncological center.

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