Laparoscopic Radical Trachelectomy: Technique, Feasibility, and Outcomes

Abstract

Background and Objectives:Our objectives are to describe our surgical technique for laparoscopic radical trachelectomy, to evaluate its feasibility, and to present the perioperative results at Hospital Italiano de Buenos Aires, Argentina.Methods:We analyzed 4 patients who underwent laparoscopic radical trachelectomy for early-stage cervical cancer between December 2011 and May 2013.Results:Four patients were included in this study. Total laparoscopic radical trachelectomy was performed in all cases. The mean age was 26 years (range, 19–32 years), the mean body mass index was 21 (range, 18–23), and the mean length of hospital stay was 33 hours (range, 24–36 hours). The mean operative time was 225 minutes (range, 210–240 minutes), and no complications were reported. During the postoperative period, only 1 patient presented with left vulvar edema, which resolved spontaneously. The pelvic and parametrial lymph nodes, as well as the vaginal cuff and cervical resection margins, were negative for malignancy in all cases. On average, 18 pelvic lymph nodes (range, 15–20) were removed. The tumor stage was IB in all 4 patients, and the mean tumor size was 17 mm (range, 12–31 mm). No patient required conversion to laparotomy.Conclusion:We consider laparoscopic radical trachelectomy, performed by trained surgeons, a feasible and safe therapeutic option as a fertility-sparing surgical technique, with good perioperative outcomes for women with early-stage cervical cancer with a desire to preserve their fertility. Minimally invasive surgery provides the widely known benefits of this type of approach.

Variation in outcome reporting in studies of fertility‐sparing surgery for cervical cancer: A systematic review

“…The literature search yielded a total of 937 studies, of which 355 duplicates were removed; 582 titles were screened against our inclusion criteria, and 452 abstracts were fully assessed. Of those abstracts, 130 full texts were scrutinised, and 51 failed to meet the inclusion criteria, leaving 79 studies for inclusion in our analysis 25,38–115 . Additionally, the literature search yielded several systematic reviews, which were manually assessed, and we identified a further 25 studies not captured by the initial literature search 26,116–139 …”

Radical trachelectomy: Ten-year experience of the P.A. Herzen Moscow Oncology Research Institute

“…За последние несколько лет в литературе увеличилось число сообщений о выполнении РЛТ, подразумевающей реализацию всех этапов операции видеоэндоскопическим способом. Систематизированную информацию о результатах применения РЛТ в настоящее время сложно представить в связи с относительно небольшим числом больных в обследуемых группах и малыми сроками наблюдения [13,14]. Данный вариант РТ сочетает преимущества абдоминального подхода в аспекте онкологической радикальности и малую травматичность оперативной лапароскопии.…”

Traquelectomía radical laparoscópica en pacientes con cáncer de cuello uterino en estado IB1 en el Instituto de Cancerología - Las Américas, Medellín, Colombia

“…En Asia, Lee en 2003 (5), publica el primer reporte con 2 pacientes, posteriormente Cibula en 2005 (9), reporta el primer caso en Europa, y desde entonces múltiples autores han publicado sus resultados (10)(11)(12)(13)(14)(15)(16)(17)(18)(19). El más grande de ellos por Park y cols con 79 pacientes (20), de las cuales 29 tenían tumores mayores a 2 cms (Tablas II, III, IV).…”