Laparoscopic Nerve-Sparing Radical Trachelectomy: Surgical Technique and Outcome

Abstract 

Study Objective

To assess the feasibility of the laparoscopic approach in fertility-preserving and radical surgery of cervical cancer in young patients.

Design

Retrospective study (Canadian Task Force classification I).

Setting

Hospital Son Llatzer, Palma de Mallorca, Spain.

Patients

Nine women with early cervical cancer.

Intervention

Laparoscopic nerve-sparring radical trachelectomy.

Measurements and Main Results

Data for 9 consecutive women undergoing laparoscopic nerve-sparing radical trachelectomy because of FIGO IA2 (n = 2) or FIGO IB1 (n = 7) infiltrating cervical carcinoma of the squamous type (n = 6) or adenocarcinoma (n = 3) were analyzed. Resection of the pericervical ligaments was laparoscopically performed, preserving innervation of the bladder and the arterial supply of the uterus. The laparoscopic approach enabled completion of the operation via the vaginal route without difficulties. The mean duration of surgery was 270 minutes. No relevant perioperative complications occurred. Two women became pregnant: 1 underwent an elective cesarean section delivery at week 38, and hysterectomy was performed 6 months later; and the other woman was pregnant at the time of this writing. Mean duration of follow-up was 28 months. Six patients currently have regular menses without evidence of disease. One patient had a central recurrence at 14 months, which was treated using surgery and radiochemotherapy, and she was free of disease at the last follow-up.

Conclusions

Laparoscopic nerve-sparring radical trachelectomy may be an alternative in fertility-preserving surgery for cervical cancer in centers in which specialization in radical vaginal surgery is lacking. The procedure enables preservation of autonomic innervation of the urinary bladder and the arterial supply of the uterus.