Total Laparoscopic Nerve-Sparing Radical Trachelectomy

Objectives: To evaluate the feasibility and operative morbidity of a total laparoscopic nerve-sparing radical trachelectomy with pelvic lymphadenectomy. Methods: Between July 2004 and May 2005, this procedure had been undergone to four consecutive young patients with early cervical cancer (one with stage IA2, three with stage IB1). It was distinguished from the conventional radical trachelectomy in that it consisted of a reanastomosis of uterine corpus and upper vagina via laparoscopic approach, and an autonomic nerve-sparing dissection under the magnified laparoscopic view. Results: The mean operative time and blood loss was 250 minutes and 185 mL, respectively. The pathologic diagnosis was all squamous cell carcinoma. There were no node metastasis and cancer-free cervical margin. Any wound defect and leakage from a stump were not found. There were no neurologic impairments such as bladder hypotonia. The mean follow-up period was 34 months. Only one patient (Case 1) received concurrent chemo-radiation due to recurrence, followed by no further sign of progression. Unfortunately, there has not been any pregnancy yet. Conclusion: A total laparoscopic nerve-sparing radical trachelectomy is feasible and without any increase of morbidity, and has the potential to improve surgical outcomes, compared with a conventional radical trachelectomy.