Abstract
We present a retrospective case series of patients who underwent robotic-assisted laparoscopic trachelectomies from August 1, 2011 to August 30, 2012, with a description of the surgical technique for successful cervical removal. The patients, at the Department of Obstetrics and Gynecology, Division of Urogynecology and Minimally Invasive Surgery at Penn State Milton S. Hershey Medical Center, were identified using ICD-9 coding for robotic-assisted trachelectomy. Of the 180 patients who had robotic-assisted gynecologic surgery during the study period, eight underwent robotic-assisted laparoscopic trachelectomy. The patients’ average age was 40.4 years, average parity was 1.5, and mean body mass index was 28. The time interval from initial surgery of supracervical hysterectomy to robotic-assisted trachelectomy was 4 years. Pre-operative cervical cytology was negative in all patients. The average length of stay was one overnight admission. The primary indication for prior supracervical hysterectomy was dense pelvic adhesions, and the main indications for robotic-assisted trachelectomy were pelvic pain due to endometriosis and cyclic vaginal bleeding. Surgical outcomes included minimal blood loss (<50 ml) and mean operative time of 1.15 h (74.88 min), without any immediate intra-operative or post-operative complications reported. Histopathology reports on all cervical specimens were normal. Adnexectomy is the most common concomitant procedure performed with trachelectomy. Robotic-assisted laparoscopic trachelectomy is a viable option for patients requesting a minimally invasive approach to cervical stump removal.
Similar content being viewed by others
References
Howard FM (2011) Laparoscopic hysterectomy. In: Rock JA, Jones HW (eds) TeLinde’s operative gynecology, 10th edn. Lippincott Williams and Wilkins, Philadelphia, pp 763–773
Lyons TL, Adolph AJ, Winer WK (2004) Laparoscopic supracervical hysterectomy for the large uterus. J Am Assoc Gynecol Laparosc 11:170–174
Bojahr B, Raatz D, Schonleber G, Abri C, Ohlinger R (2006) Peri-operative complication rate in 1,706 patients after a standardized laparoscopic supracervical hysterectomy technique. J Minim Invasive Gynecol 13(3):183–189
Lyons TL (1995) Subtotal hysterectomy. In: Diamond MP, Daniell JF, Jones HA (eds) Hysterectomy. Blackwell Scientific, MA, pp 84–98
Johns A (1997) Supracervical versus total hysterectomy. Clin Obstet Gynecol 40:903–913
Killku P, Gronroos M (1982) Preoperative electrocoagulation of endocervical mucosa and later carcinoma of the cervical stump. Acta Obstet Gynecol Scand 61:265–267
Esdaile BA, Chailian RA, Del Priore G, Smith JR (2006) The role of supracervical hysterectomy in benign disease of the uterus. J Obstet Gynaecol 26:52–58
Sills ES, Saini J, Applegate MS, McGee M, Gretz HF (1998) Supracervical and total abdominal hysterectomy trends in New York State: 1990–1996. J Urban Health 75:903–910
Hilger WS, Pizarro AR, Magrina JF (2005) Removal of the retained cervical stump. Am J Obstet Gynecol 193:2117–2121
Hoffman CP, Kennedy J, Borschel L, Burchette R, Kidd A (2005) Laparoscopic hysterectomy: the Kaiser Permanente San Diego experience. J Minim Invasive Gynecol 12:16–24
Jenkins TR (2004) Laparoscopic supracervical hysterectomy. Am J Obstet Gynecol 191:1875–1884
Lyons TL (1993) Laparoscopic supracervical hysterectomy: a comparison of morbidity and mortality results with laparoscopically assisted vaginal hysterectomy. J Reprod Med 38:763–767
Nezhat CH, Rogers JD (2008) Robot-assisted laparoscopic trachelectomy after supracervical hysterectomy. Fertil Steril 90:850.e1–850.e3
Burnett AF, Stone PJ, Duckworth LA, Roman JJ (2009) Robotic radical trachelectomy for preservation of fertility in early cervical cancer: case series and description of technique. J Minim Invasive Gynecol 16:569–572
Chuang LT, Lerner DL, Liu CS, Nezhat FR (2008) Fertility-sparing robotic-assisted radical trachelectomy and bilateral pelvic lymphadenectomy in early-stage cervical cancer. J Minim Invasive Gynecol 15:767–770
Magrina JF, Zanagnolo VL (2008) Robotic surgery for cervical cancer. Yonsei Med J 49(6):879–885
Okaro EO, Jones KD, Sutton C (2001) Long term outcome following laparoscopic supracervical hysterectomy. Br J Obstet Gynecol 108:1017–1020
Nezhat CH, Nezhat F, Roemisch M, Seidman D, Nezhat C (1996) Laparoscopic trachelectomy for persistent pelvic pain and endometriosis after supracervical hysterectomy. Fertil Steril 66:925–928
ACOG Committee Opinion No. 388 (2007) Supracervical hysterectomy. Obstet Gynecol 110(5):1215–1217
Ghomi A, Hantes J, Lotze EC (2005) Incidence of cyclical bleeding after laparoscopic supracervical hysterectomy. J Minim Invasive Gynecol 12:201–205
Van der Stege JG, Van Beek JJ (1999) Problems related to cervical stump at follow-up in laparoscopic supracervical hysterectomy. J Soc Laparosc Surg 3:335–336
Learman LA, Summitt RL Jr, Varner RE, McNeeley SG, Goodman-Gruen D, Richter HE et al (2003) A randomized comparison of total or supracervical hysterectomy: surgical complications and clinical outcomes. Total or Supracervical Hysterectomy (TOSH) Research Group. Obstet Gynecol 102:453–462
Thakar R, Ayers S, Clarkson P, Stanton S, Manyonda I (2002) Outcomes after total versus subtotal abdominal hysterectomy. N Engl J Med 347:1318–1325
Gimbel H, Zobbe V, Andersen BJ et al (2005) Lower urinary tract symptoms after total and subtotal hysterectomy results of a randomized controlled trial. Int Urogynecol J Pelvic Floor Dysfunct 16(4):257–262
Conflict of interest
The authors have full control of all primary data and they agree to allow the journal to review their data if requested. Dr. Tam and Dr. Davies declare that they have no conflict of interest. Dr. Harkins is a consultant to Ethicon and Intuitive Surgical.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Tam, T., Harkins, G. & Davies, M. Robotic-assisted laparoscopic trachelectomy: a case series and review of surgical technique. J Robotic Surg 7, 345–349 (2013). https://doi.org/10.1007/s11701-013-0397-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11701-013-0397-0