Surgical Approach to Laparoscopic Trachelectomy

Abstract

Study Objective

To demonstrate several reproducible strategies used to overcome the surgical challenges of laparoscopic trachelectomy.

Design

N/A.

Setting

The patient was placed in dorsal lithotomy position, in steep Trendelenburg to aid in the performance of pelvic laparoscopy. Insufflation was carried out to 15mmHg. A primary 10mm umbilical trocar was used for the camera through the mini lap and three additional 5mm assist ports were placed.

Patients or Participants

The patient is a 41-year-old G1P1001 with history of supracervical hysterectomy who presented with persistent pelvic/back pain and vaginal bleeding. Extensive workup for alternative causes were unrevealing and remaining cervix was suspected source of symptoms. With appropriate options counseling and shared-decision making, patient elected to undergo laparoscopic trachelectomy.

Interventions

Laparoscopic trachelectomy with bilateral ureteral stent placement.

Measurements and Main Results

Uncomplicated surgery with same-day discharge followed by uneventful post-operative recovery.

Conclusion

Laparoscopic trachelectomy poses many challenges to the surgeon. In this video, we present a step-wise approach and several reproducible strategies to overcome these obstacles encountered in laparoscopic trachelectomy.