Feasibility and Outcomes of “No-Look No-Touch” Laparoscopic Radical Trachelectomy for Early-Stage Cervical Cancer

Abstract

Intraoperative tumor manipulation and dissemination may compromise the survival of women with early-stage cervical cancer who undergo laparoscopic surgery. This study aimed to examine survival and obstetrical outcomes related to laparoscopic radical trachelectomy (LRT) with a “no-look no-touch” technique in 40 women. This technique incorporates five measures to prevent tumor spillage and damage to the uterine artery perfusion. Five LRTs were aborted because of positive nodes or positive surgical margins. Compared with those of type III laparoscopic radical hysterectomy, the surgical outcomes of LRT in 35 patients were acceptable: operative time (380 min), estimated blood loss (140 mL), length of hospital stay (15 days), and lengths of excised parametrium and vagina. During follow-up (median, 41.3 months), the 5-year disease-free survival and overall survival were 95.0% (95% CI: 69.5–99.3%) and 100%, respectively. Of the nine patients (26%) who attempted pregnancy, seven conceived (nine pregnancies, 76%). Eight were delivered by term cesarean section, while one was miscarried in the first trimester. Our study suggests that the no-look no-touch technique may be effective in reducing the risk of recurrence and improving obstetrical outcomes during LRT for early-stage cervical cancer.

Round ligament suspension and vaginal purse‐string suture: Newly optimized techniques to prevent tumor spillage in laparoscopic radical trachelectomy for cervical cancer

“…The 5-year survival rate of cervical cancer patients became higher as the negative lymph node (NLN) count increased, and the overall survival rate of patients with NLN counts >25 was significantly higher than that of those with NLN counts ≤25 (p < 0.001). 21 Our study achieved a median of 27 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) NLN resections. These data suggested that we optimized the surgical techniques without weakening the surgical radicality.…”

“…All patients had IA2-IB2 stage disease (FIGO 2018). The median number of pelvic lymph nodes removed was 27 (range [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Sufficient amounts of paracervical tissue (median 24 mm) and vaginal tissue (median 18 mm) were cut off.…”

“…We thought the first two risks could be avoided by technical optimization to achieve protective maneuvers, and to our knowledge, modified procedures related to these two aspects have been applied for hysterectomy in some studies. Recently, a study further proposed a “no‐look no‐touch” technique to prevent tumor spillage in LRT 26 …”

“…All of these techniques were well replaced by the use of uterine manipulators in hysterectomy only, however, relatively few similar studies have been published in LRT. Recently, Kanao et al proposed a new technique in LRT, in which a 5‐mm extra‐long trocar was inserted at the posterior incision line of the vaginal mucosa and forceps were introduced through this port to mobilize the uterus by pushing the suture attached to the uterus 26 . This technique allowed the replacement of uterine manipulator, but required an assistant to manipulate the uterus throughout the surgery from the vagina, and the suture attached to the uterus would damage its integrity.…”

“…Yuan et al 32 introduced a suture to cerclage the upper vagina, which was simple but not fixed enough and was easily displaced. Kanao et al 26 created of a vaginal cuff by closing the incised vaginal mucosa with a double layer of 12 continuous sutures before LRT, which was effective in avoiding the exposure of the tumor but complicated. In our procedure, a purse‐string suture was performed laparoscopically to close the vagina before colpotomy.…”