Surgical Techniques for Radical Trachelectomy

Background/Objectives: The primary aim of this systematic review was to evaluate fertility outcomes and the oncological safety of different surgical techniques of radical trachelectomy (RT). Methods: The systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search on PubMed, Embase, and Google Scholar was performed between 1 November 2023 and 31 March 2024 with no limits for the time of publication. Results: In total, 56 studies met the inclusion criteria: 22 for abdominal RT (1712 patients), 14 for endoscopic RT (445 patients), and 22 for vaginal RT (1158 patients). Data regarding certain steps of the procedure (uterine artery preservation, autonomous nerve-sparing, abdominal cerclage, types of sutures used for the cerclage, uterine dilatation during cerclage placement, prolongation of uterine catheterization, type of uterovaginal anastomosis, antibiotic prophylaxis, and suppression of menstruation) were extracted and analyzed with regard to the obstetrical and oncological outcomes. Endoscopic RT was associated with a significantly higher pregnancy rate and a lower rate of preterm deliveries. Uterine artery preservation was associated with a higher live birth rate. Nerve-sparing RT resulted in a higher pregnancy rate, but no differences in the attempt for pregnancy and live birth rates were observed. Conclusions: Taking into account the obstetrical outcomes, it seems that the preferred option for radical RT is an endoscopic procedure with preservation of the uterine artery and the pelvic autonomic nerves. However, the safety of the endoscopic approach should be evaluated in prospective trials.