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A modified technique of laparoscopic radical trachelectomy combined with extracorporeal cervical amputation through a mini-laparotomy

  • Zen Watanabe1
  • Hideki Tokunaga1,*,
  • Masumi Ishibashi1
  • Shogo Shigeta1
  • Keita Tsuji1
  • Tomoyuki Nagai1
  • Masahito Tachibana1
  • Muneaki Shimada1
  • Nobuo Yaegashi1

1Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, 980-8574 Miyagi, Japan

DOI: 10.31083/j.ejgo.2021.01.2278 Vol.42,Issue 1,February 2021 pp.183-188

Submitted: 20 October 2020 Accepted: 16 December 2020

Published: 15 February 2021

(This article belongs to the Special Issue Minimally Invasive Surgery in Gynecologic Oncology)

*Corresponding Author(s): Hideki Tokunaga E-mail: hideki.tokunaga.a1@tohoku.ac.jp

Abstract

Radical trachelectomy is an optional fertility-sparing treatment for early-stage cervical cancer, and recently, the minimally invasive approach (MIA) has become a major trend in radical trachelectomy. MIA radical trachelectomy requires a more careful surgical technique to avoid tumor spillage and exposure of the cancerous tissue under carbon dioxide pneumoperitoneum to reduce the risk of recurrence. We present a case of a 33-year-old nulliparous woman with stage IB1 cervical cancer who underwent MIA radical trachelectomy through a combination of laparoscopic surgery and mini-laparotomy, mainly to prevent postoperative complications and tumor spread during cervical amputation. A Papanicolaou test suggested the diagnosis of squamous cell carcinoma of the cervix without any symptoms such as atypical bleeding. The subsequent biopsy revealed squamous cell carcinoma with stromal invasion of the cervix. Cervical amputation was performed extracorporeally through a small incision in the lower abdomen. There were no perioperative complications. The patient was discharged on postoperative day 13. The final pathological evaluation revealed residual microinvasive cancer of the endocervical canal with clear margins, no lymphovascular space involvement, and 27 negative lymphatic nodes. The joint of the neo-cervix and vagina had healed completely without erosion or stenosis of the cervical canal, and no problems occurred during sexual intercourse. No cancer recurrence or menstrual disorders have been reported in the short postoperative period of 6 months. The surgical technique of laparoscopic radical trachelectomy combined with extracorporeal cervical amputation may be an acceptable alternative to reduce the risk of recurrence by preventing intraperitoneal tumor spillage.


Keywords

Cervical cancer; Radical trachelectomy; Minimally invasive approach; Fertility preservation; Mini-laparotomy; Cervical amputation; Extracorporeal


Cite and Share

Zen Watanabe,Hideki Tokunaga,Masumi Ishibashi,Shogo Shigeta,Keita Tsuji,Tomoyuki Nagai,Masahito Tachibana,Muneaki Shimada,Nobuo Yaegashi. A modified technique of laparoscopic radical trachelectomy combined with extracorporeal cervical amputation through a mini-laparotomy. European Journal of Gynaecological Oncology. 2021. 42(1);183-188.

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