Pulling the uterus directly instead of relying on the uterine manipulator: a better surgical technique choice for laparoscopic radical resection of cervical cancer

: Cervical cancer is one of the most common malignant tumors among women. The appropriate treatment plan is determined based on factors such as the clinical stage, age of the patient, fertility requirements, general condition and medical expertise. Patients are typically treated with surgery or radiotherapy, along with chemotherapy if necessary. Surgical treatment is typically reserved for patients with early-stage cervical cancer (IA–IIA). In recent years, advancements in screening technology and increased individuals’ awareness of physical examinations have led to a higher rate of early diagnosis for cervical cancer. Thus, it is of vital importance for patients with cervical cancer to undergo surgery treatment, as most patients are in the early stage of the disease when they are first diagnosed and have good prognosis. With the advancement of the minimally invasive concept and technology, laparoscopy has emerged as a surgical treatment method for cervical cancer. It offers several advantages such as reducing intraoperative blood loss, decreasing the rate of wound infection, shortening hospital stay, and not increasing postoperative complications. On the other hand, studies have indicated that laparoscopic radical hysterectomy is associated with lower survival rates and higher recurrence rates compared to conventional open surgery. The potential reasons for the unfavorable prognosis of laparoscopic surgery may be attributed to the use of uterine manipulator, CO 2 pneumoperitoneum, and the treatment of the vaginal stump. In light of the limitations of laparoscopic radical hysterectomy, previous studies have utilized various techniques such as the myoma screw, grasping forceps, uterine hitch technique and uterine rein technique instead of a uterine manipulator. However, these techniques still pose risks such as longer operation time and uterine fragmentation. Consequently, we are continuously working to address the shortcomings of laparoscopic radical hysterectomy. The objective of this video is to present a surgical approach that does not involve the use of a uterine manipulator or its alternatives, by pulling the uterus directly, with the aim of achieving a tumor-free outcome during laparoscopic radical hysterectomy. This approach is intended to preserve the advantages of laparoscopic radical hysterectomy surgery while overcoming the disadvantages of reduced long-term survival and increased recurrence rates.