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• W3091963894 abstract "Study Objective Minimally invasive surgery decreases postoperative morbidity after radical hysterectomy (RH) for early-stage cervical cancer. However, a randomized trial and large retrospective data question its safety after observing lower rates of survival than open surgery [ 1 Ramirez PT Frumovitz M Pareja R et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med. 2018; 379: 1895-1904 Crossref PubMed Scopus (860) Google Scholar , 2 Melamed A Margul DJ Chen L et al. Survival after minimally invasive radical hysterectomy for early-stage cervical cancer. N Engl J Med. 2018; 379: 1905-1914 Crossref PubMed Scopus (383) Google Scholar ]. The causes of this higher recurrence rate are not definitely established but may result from cancer exposure to the peritoneum during vaginal section and cancerous cells’ spillage enhanced by pneumoperitoneum or a uterine manipulator. The aim of this surgical video was to present a standardized step-by-step approach for robotic RH according to the recent recommendations from the ARCAGY –Group of National Investigators for the Study of Ovarian and Breast Cancers surgeon's group [ 3 Uccella S Malzoni M Cromi A et al. Laparoscopic vs transvaginal cuff closure after total laparoscopic hysterectomy: a randomized trial by the Italian Society of Gynecologic Endoscopy. Am J Obstet Gynecol. 2018; 218: 500.e1-500.e13 Abstract Full Text Full Text PDF Scopus (37) Google Scholar ]. Design Step-by-step video demonstration of the technique. Setting Tertiary center specialized in gynecologic oncology and minimally invasive surgery. Interventions A 48-year-old woman was diagnosed with a stage IB2 endocervical adenocarcinoma (International Federation of Gynecology and Obstetrics 2018) with a tumor size of 27 mm. Surgery was planned after preoperative pulsed dose rate uterovaginal brachytherapy. Surgery was performed following 10 reproducible steps: • Pelvic sentinel node identification according to the SENTICOL-III trial • Right infundibulopelvic and round ligaments transection • Right uterine vessels transection • Parametrectomy • Right uterosacral ligament transection • Bladder mobilization • Identical left dissection • Rectovaginal space development • Colpectomy by vaginal route after complete pneumoperitoneum exsufflation • Robotic vaginal cuff closure and pelvic inspection Thorough robotically assisted vaginal cuff closure was carried out as a comparative study suggesting that abdominal closure may decrease vaginal complications and dehiscence [ 3 Uccella S Malzoni M Cromi A et al. Laparoscopic vs transvaginal cuff closure after total laparoscopic hysterectomy: a randomized trial by the Italian Society of Gynecologic Endoscopy. Am J Obstet Gynecol. 2018; 218: 500.e1-500.e13 Abstract Full Text Full Text PDF Scopus (37) Google Scholar ]. Conclusion No international recommendations for the RH approach have yet been endorsed. Patients must be clearly informed about the benefit-risk ratio of the surgical route. If a minimally invasive RH is still decided, the patient should be referred to experienced centers, and precautionary measures must be implemented [ 4 Pomel C Lecuru F Leblanc E et al. Minimal invasive surgery for early stage cervical cancer. Recommendations from the GINECO surgeon's group [Article in French]. Bull Cancer. 2019; 106: 939-940 Crossref PubMed Scopus (2) Google Scholar ]. Colpotomy by vaginal route without pneumoperitoneum is recommended. Uterine manipulators have to be strictly avoided. Preoperative brachytherapy has been reported in experienced centers in France with favorable histologic response with high rates of pathologic complete response (near 70%) and seems particularly worthwhile for tumor sizes ranging from 2 to 4 cm or presenting with lymphovascular invasion [ 5 Escande A Gouy S Mazeron R et al. Outcome of early stage cervical cancer patients treated according to a radiosurgical approach: Clinical results and prognostic factors. Gynecol Oncol. 2017; 144: 541-546 Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar ]." @default.
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• W3091963894 date "2021-06-01" @default.
• W3091963894 modified "2023-09-27" @default.
• W3091963894 title "Robotic Radical Hysterectomy for Cervical Adenocarcinoma after Preoperative Brachytherapy in 10 Steps" @default.
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• W3091963894 doi "https://doi.org/10.1016/j.jmig.2020.10.001" @default.
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