Vaginal-Assisted Laparoscopic Radical Cervical Cancer Resection Without Uterine Manipulation

Abstract

Cervical cancer surgery has strict indications that are limited to early-stage cervical cancer. Radical cervical cancer resection is generally perform in a tumor-free environment, whereas both standard open surgery and classic minimally invasive vaginal surgery emphasize the principles of tumor-free operations. On one hand, with the increasing promotion of laparoscopic or da Vinci surgery, radical cervical cancer resection using these approaches has been widely commended as they facilitate the excellent surgical field visualization and a long-arm effect. However, this procedure involves direct compression of the lesion during uterine manipulation and opening of the lesion during vaginal transection, which has cast doubt over the efficacy of this technique. On the other hand, vaginal radical cervical cancer resection is a mature technique adopted for the surgical treatment of cervical cancer since the beginning of the twentieth century, and can be considered a classic minimally invasive surgery for cervical cancer. However, its disadvantages, including the need for retrograde dissection and a limited surgical field, have impeded its technical advancement, and the learning curve associated with the procedure has also hindered its widespread promotion. Therefore, use of the two surgical approaches as complements to each other will not only simplify the surgical techniques involved but also help surgeons adhere to the tumor-free principle of minimally invasive surgery for cervical cancer.