title: Laparoscopic Vaginal-Assisted Nerve-Sparing Radical Trachelectomy.
abstract: OBJECTIVE
  To demonstrate a laparoscopic vaginal-assisted nerve-sparing radical trachelectomy.
  
  
  METHODS
  An edited educational video, including a step-by-step description of the procedure.
  
  
  METHODS
  Radical trachelectomy is the main surgical indication for selected cases of initial cervical cancer with a fertility-sparing approach. Although transvaginal access is the most traditional route, this technique has not gained widespread acceptance because of the complexity of the ureteral dissection and the limited amount of resected parametrial tissue. This video describes a laparoscopic technique including an adequate parametrial resection with autonomic preservation (C1 level) and a standard laparoscopic ureteric dissection under direct visualization. All parametrial dissections were performed by laparoscopy using a nerve-sparing technique. The uterine vessels were well dissected and transected at their origin. The colpotomy was performed by laparoscopy with a 1-cm vaginal margin using a monopolar energy hook. To achieve an adequate endocervical margin and to avoid thermal injury to the endocervix, the cervical section was performed transvaginally with a cold knife. The specimen was then retrieved, and a segment of the remaining cervix was removed for frozen section analysis. If the margin was free of tumor, the cervical-vaginal anastomosis was performed transvaginally. An endocervical device was placed to avoid postoperative cervical stenosis.
  
  
  METHODS
  Laparoscopic vaginal-assisted nerve-sparing radical trachelectomy.
  
  
  CONCLUSIONS
  This video demonstrates a reproducible laparoscopic technique for radical trachelectomy with a nerve-sparing technique. The vaginal route was used at the moment of sectioning the cervix/isthmus to permit adequate margin evaluation.
authors.affiliation: Department of Gynecologic Oncology, Barretos Cancer Hospital, Brazil. Electronic address: mvieiraonco@gmail.com.
authors.forename: Marcelo
authors.initials: M
authors.lastname: de Andrade Vieira
authors.affiliation: Department of Gynecologic Oncology, Barretos Cancer Hospital, Brazil.
authors.forename: Geórgia Fontes
authors.initials: GF
authors.lastname: Cintra
authors.affiliation: Department of Gynecologic Oncology, Barretos Cancer Hospital, Brazil.
authors.forename: Ricardo
authors.initials: R
authors.lastname: dos Reis
authors.affiliation: Department of Gynecologic Oncology, Barretos Cancer Hospital, Brazil.
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Andrade
authors.affiliation: Department of Gynecologic Oncology, Barretos Cancer Hospital, Brazil.
authors.forename: Audrey Tieko
authors.initials: AT
authors.lastname: Tsunoda
mesh_terms: D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D017410:Practice Guidelines as Topic; D000069339:Trachelectomy / Q000379:methods*; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000601:surgery*; D014621:Vagina / Q000473:pathology / Q000601:surgery*
keywords: Cervical cancer; Cervix; Laparoscopy; Nerve sparing; Pelvic lymphadenectomy; Radical trachelectomy; Vaginal assisted