Vaginal-Assisted Laparoscopic Radical Trachelectomy

Abstract

Vaginal-assisted laparoscopic radical trachelectomy (VALRT) is mainly applicable to patients with early cervical cancer who need to preserve their fertility. VALRT involves extensive resection of the cervix, paracervical tissues, and other parts of the vagina. Following radical trachelectomy, the preserved uterus and vaginal stump are anastomosed and reconstructed. This procedure fully utilizes the vagina as a natural orifice, and involves a two-pronged internal and external surgical approach. First, abdominal operations are completed laparoscopically, including pelvic lymph node dissection, ureter mobilization, mobilization, and dissection of the ascending branch of the uterine artery to the uterine isthmus, and transection of the inferior vaginal margin. Vaginal operations are then performed, including transvaginal pull-through of the uterus for transection, shaping, and cerclage at the uterine isthmus. Finally, the vagina and uterus are anastomosed transvaginally to complete the reconstruction of the reproductive tract. VALRT is an ideal combination of laparoscopic minimally invasive surgery and vaginal natural orifice surgery, with an emphasis on the principles of tumor-free operation. These features are in perfect alignment with the current novel concepts of natural orifice specimen extraction surgery (NOSES). Furthermore, the focus of this procedure is fertility preservation in young women; it helps patients with cervical cancer who are of childbearing age to fulfill their desire of motherhood. Not only does this procedure involve the improvement of postoperative quality of life, but also embodies a type of humanitarian care that imbues gynecological NOSES with greater meaning.

As a recently developed technique, VALRT involves complex procedures and places high demands on the surgeon’s anatomical knowledge and operating skills. Thus, this procedure has not been widely promoted as yet. Nevertheless, several young patients with cervical cancer have been treated using this procedure and have subsequently achieved their fertility needs. Therefore, popularization of this procedure is essential for the benefit of such patients.