Extraperitoneal radical trachelectomy with pelvic lymphadenectomy

Area of Science:

• Gynecology
• Surgical Oncology
• Reproductive Medicine

Background:

• Radical trachelectomy with pelvic lymphadenectomy is used for fertility preservation in early-stage cervical cancer.
• Existing surgical approaches can cause peritoneal damage, potentially leading to periadnexal adhesions and subsequent infertility.
• Minimizing peritoneal damage is crucial for successful fertility-sparing surgery.

Purpose of the Study:

• To describe a novel extraperitoneal surgical approach for radical trachelectomy.
• To detail the step-by-step technique aimed at minimizing peritoneal damage during fertility-preserving surgery for cervical cancer.

Main Methods:

• Development of a new surgical technique based on type III radical hysterectomy principles, performed entirely via an extraperitoneal approach.
• Detailed description of surgical steps including extraperitoneal pelvic lymphadenectomy, ligament dissection, cervical transection, cerclage, anastomosis, and preservation of key neurovascular structures.
• Utilization of conventional, low-cost surgical instruments.

Main Results:

• The described extraperitoneal approach completely avoids peritoneal injuries.
• The technique allows for preservation of uterine arteries, inferior hypogastric nerve, and pelvic splanchnic nerve.
• The procedure can be performed using standard, affordable surgical instruments.

Conclusions:

• The novel extraperitoneal radical trachelectomy technique effectively minimizes peritoneal damage, a key factor in preserving fertility.
• This approach offers a potentially ideal fertility-sparing treatment option for selected patients with early-stage cervical cancer.
• Further clinical studies are required to evaluate the oncological and reproductive outcomes of this new surgical method.