Laparoscopic radical trachelectomy and pelvic lymphadenectomy without uterine manipulator

With the postponement of marriage and childbearing in modern society, an increasing proportion of patients diagnosed with cervical cancer are young and have not yet completed their reproductive plans. Fertility-preserving surgery, such as radical trachelectomy, plays an important role in selected patients with early-stage disease. However, the use of a uterine manipulator during minimally invasive surgery remains controversial.

We present a surgical film demonstrating laparoscopic radical trachelectomy and pelvic lymphadenectomy without the use of a uterine manipulator in a young woman with early-stage cervical cancer. The patient was a 29-year-old nulliparous woman diagnosed with stage IB1 cervical squamous cell carcinoma following cervical conization, with a strong desire for fertility preservation.Instead of a uterine manipulator, uterine suspension was adopted using absorbable sutures to coil the bilateral round ligaments with the anterior uterine wall, allowing controlled uterine traction. Bilateral pelvic lymphadenectomy was performed first, and frozen section analysis confirmed the absence of lymph node metastasis. Radical trachelectomy was subsequently carried out, with careful management of the vesicouterine ligament, preservation of the uterine artery branch, and protection against tumor exposure during colpotomy. Reconstruction of the residual cervix and vagina was performed using the cuff-sleeve suture technique, followed by placement of a cervical stent.

This surgical film demonstrates a uterine manipulator-free laparoscopic radical trachelectomy with pelvic lymphadenectomy for early-stage cervical cancer. The described uterine suspension technique provides adequate exposure while maintaining uterine integrity. This approach may facilitate fertility preservation without compromising oncologic principles in carefully selected patients.