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.

scholarly journals Outcomes of Trachelectomy vs. Hysterectomy for Early-Stage Cervical Cancer: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Juan Guo ◽  
Qingwei Hu ◽  
Zaixing Deng ◽  
Xiaotian Jin
Keyword(s):  
Cervical Cancer ◽  
Blood Loss ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Operative Time ◽  
Early Stage ◽  
Meta Analysis ◽  
Radical Trachelectomy ◽  
Risk Of Recurrence ◽  
Early Stage Cervical Cancer

Objective: To provide updated evidence on comparative efficacy for clinical outcomes of radical trachelectomy and radical hysterectomy in patients with early-stage cervical cancer.Methods: A systematic search was conducted in the PubMed, Scopus, Cochrane Database of Systematic Reviews, and Google scholar databases. Studies were done in patients with early-stage cervical cancer that compared the outcomes between radical trachelectomy (RT) and hysterectomy (RH) were considered for inclusion in the review. The outcomes of interest were operative time, the volume of blood loss, need for blood transfusion, any complications, length of hospital stay, risk of recurrence, and survival. The strength of association was presented in the form of pooled relative risk (RR), hazards risk (HR), and weighted mean difference (WMD). Statistical analysis was done using STATA version 16.0.Results: A total of 12 articles were included in the meta-analysis. The majority were retrospective cohort-based studies. Compared to RH, the operative time (in min) was comparatively higher in RT (WMD 23.43, 95% CI: 5.63, 41.24). Patients undergoing RT had blood loss (in ml) similar to those undergoing RT (WMD −81.34, 95% CI: −170.36, 7.68). There were no significant differences in the risk of intra-operative (RR 1.61, 95% CI: 0.49, 5.28) and post-operative complications (RR 1.13, 95% CI: 0.54, 2.40) between the two groups. Patients in the RT group had lesser duration of post-operative hospital stay (in days) (WMD −1.65, 95% CI: −3.22, −0.09). There was no statistically significant difference in the risk of recurrence (HR 1.21, 95% CI: 0.68, 2.18), 5-year overall survival (HR 1.00, 95% CI: 0.99, 1.02), and recurrence-free survival (HR 0.99, 95% CI: 0.96, 1.01) between the two groups.Conclusion: Among the patients with early-stage cervical cancer, RT is similar to RH in safety and clinical outcomes. Future studies with a randomized design and larger sample sizes are needed to further substantiate these findings.

Laparoscopic Radical Trachelectomy Is an Alternative to Laparotomy With Improved Perioperative Outcomes in Patients With Early-Stage Cervical Cancer

2014 ◽  
Vol 24 (1) ◽  
pp. 135-140 ◽  
Author(s):  
Ali Kucukmetin ◽  
Ioannis Biliatis ◽  
Nithya Ratnavelu ◽  
Amit Patel ◽  
Iain Cameron ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Length Of Stay ◽  
Blood Loss ◽  
Early Stage ◽  
Demographic Data ◽  
Laparoscopic Approach ◽  
Perioperative Outcomes ◽  
Radical Trachelectomy ◽  
Late Morbidity ◽  
Early Stage Cervical Cancer

ObjectiveRadical trachelectomy is an established surgical approach for managing young women with cervical cancer wishing to preserve fertility. The aim of this study was to compare perioperative outcomes between laparoscopic (LRT) and abdominal radical trachelectomy (ART).MethodsWe reviewed the records of all women undergoing either LRT or ART in our institution since 2004. Demographic data, clinicopathologic data, and perioperative outcomes were collected and compared between the 2 procedures.ResultsOverall, 27 women were identified. All of them had stage IB1 disease. Eleven (40.8%) women underwent LRT, whereas 16 (59.2%) women underwent ART. Age, parity, and body mass index, as well as histologic type, grade, and presence of lymphovascular space invasion were comparable between groups. The median length of the parametrial tissue removed was shorter in LRT versus ART (P = 0.022). The median blood loss and length of stay were significantly reduced in the LRT group (85 vs 800 mL, P < 0.001; and 4 versus 7 days, P = 0.003). The median operative time was longer with the laparoscopic approach (320 versus 192.5 minutes, P < 0.001). Early grade 1 to 2 postoperative morbidity (mainly high urinary residuals) was comparable between groups; however, more grade 3 and late morbidity events were recorded in the ART group.ConclusionsThis first comparison study between LRT and ART for fertility preservation in women with cervical cancer shows that laparoscopy performed better in terms of blood loss and length of stay. Laparoscopic radical trachelectomy could be the preferred option for these patients; however, further studies are needed to confirm comparable survival outcomes.

Early and late morbidity of radical hysterectomy with lymphadenectomy in early-stage cervical cancer: A prospective multicentric cohort of 232 patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17007-e17007
Author(s):  
Vincent Balaya ◽  
Léa Rossi ◽  
Charlotte Ngo ◽  
Anne-Sophie Bats ◽  
Patrice Mathevet ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Femoral Nerve ◽  
Pelvic Lymphadenectomy ◽  
Nerve Sparing ◽  
Node Biopsy ◽  
Urinary Infections ◽  
Late Morbidity ◽  
Early Stage Cervical Cancer

e17007 Background: The aim of this study was to assess the early and late post-operative morbidity of patients who have undergone a radical hysterectomy (RH) for early-stage cervical cancer. Methods: We retrospectively analyzed the data of two prospective trials on sentinel node biopsy for cervical cancer (SENTICOL I & II). Patients underwent a radical hysterectomy for early-stage cervical cancer between January 2005 and March 2012 in 23 French oncologic centers. Results: A total of 412 patients were enrolled and 284 had a radical hysterectomy. Data were complete for 232 patients: 115 by laparoscopic-assisted vaginal way, 80 patients by total laparoscopic way, 9 patients by total vaginal way, 22 patients by laparotomy and 6 patients by robot-assisted way. The median age was 44 years (range = 25-85 years). 89.6 % of patients had a stage IB1 disease. 72.4% were epidermoid carcinoma and 24.6% adenocarcinoma. Eighty-one patients (35%) had only a sentinel lymph node biopsy and 151 patients (65%) had an additional pelvic lymphadenectomy. There were 45 cases of urinary infections (19.4%), 17 cases of dysuria (7.3%), 10 cases of urinary incontinence (4.3%), and 6 cases of ureteral or vesical fistula (2.6%). The genito-femoral nerve was injured in 25 cases (10.7%) and the obturator nerve was injured in 22 cases (9.5%). There were 38 cases of limb lymphedema (16.3%) and 14 cases of pelvic lymphocyst (6%). Conclusions: These complications rates are similar with those found in the current literature. Urinary infections and limb lymphedema are the main complications of RH. The functional outcomes could be improved by applying nerve-sparing techniques. [Table: see text]

Nerve Sparing in Radical Surgery for Early-Stage Cervical Cancer: Yes We Should!

2010 ◽  
Vol 20 (Suppl 2) ◽  
pp. S39-S41 ◽  
Author(s):  
Cornelis D. de Kroon ◽  
Katja N. Gaarenstroom ◽  
Mariette I. E. van Poelgeest ◽  
Alexander A. Peters ◽  
J. Baptist Trimbos
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Radical Surgery ◽  
Early Stage ◽  
Surgical Techniques ◽  
Pelvic Lymphadenectomy ◽  
Nerve Sparing ◽  
Autonomic Nerves ◽  
Early Stage Cervical Cancer

Radical hysterectomy with pelvic lymphadenectomy is considered to be the cornerstone in the treatment of early-stage cervical cancer. Although survival in early-stage cervical cancer is up to 95%, long-term morbidity with regard to bladder, bowel, and sexual function is considerable. Damage to the pelvic autonomic nerves may be the cause of these long-term complications following radical hysterectomy. Some authors have presented surgical techniques to preserve the autonomic nerves (ie, the hypogastric nerves and the splanchnic nerves) without compromising radicality. Safety, efficacy, and the surgical techniques of nerve-sparing radical hysterectomy are presented, and data confirm that whenever the decision is made to perform a radical hysterectomy, nerve-sparing techniques should be considered.

scholarly journals Feasibility and Outcomes of “No-Look No-Touch” Laparoscopic Radical Trachelectomy for Early-Stage Cervical Cancer

2021 ◽  
Vol 10 (18) ◽  
pp. 4154
Author(s):  
Hiroyuki Kanao ◽  
Yoichi Aoki ◽  
Atsushi Fusegi ◽  
Makiko Omi ◽  
Hidetaka Nomura ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Early Stage ◽  
Disease Free Survival ◽  
Length Of Hospital Stay ◽  
First Trimester ◽  
Radical Trachelectomy ◽  
Obstetrical Outcomes ◽  
Estimated Blood Loss ◽  
Early Stage Cervical Cancer ◽  
Tumor Spillage

Intraoperative tumor manipulation and dissemination may compromise the survival of women with early-stage cervical cancer who undergo laparoscopic surgery. This study aimed to examine survival and obstetrical outcomes related to laparoscopic radical trachelectomy (LRT) with a “no-look no-touch” technique in 40 women. This technique incorporates five measures to prevent tumor spillage and damage to the uterine artery perfusion. Five LRTs were aborted because of positive nodes or positive surgical margins. Compared with those of type III laparoscopic radical hysterectomy, the surgical outcomes of LRT in 35 patients were acceptable: operative time (380 min), estimated blood loss (140 mL), length of hospital stay (15 days), and lengths of excised parametrium and vagina. During follow-up (median, 41.3 months), the 5-year disease-free survival and overall survival were 95.0% (95% CI: 69.5–99.3%) and 100%, respectively. Of the nine patients (26%) who attempted pregnancy, seven conceived (nine pregnancies, 76%). Eight were delivered by term cesarean section, while one was miscarried in the first trimester. Our study suggests that the no-look no-touch technique may be effective in reducing the risk of recurrence and improving obstetrical outcomes during LRT for early-stage cervical cancer.

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