Obstet Gynecol Sci.  2022 Nov;65(6):542-551. 10.5468/ogs.22094.

Surgical outcomes of laparoscopic trachelectomy following supracervical hysterectomy: a multicenter study

• Dawood AS
• Harras HF
• Moussa HR
• Soliman AS

• KMID: 2535962
• DOI: http://doi.org/10.5468/ogs.22094

Abstract

Objective
To evaluate the feasibility, safety, and surgical outcomes of laparoscopic trachelectomy after supracervical hysterectomy.
Methods
This multicenter study was conducted at Tanta University, Benha University, and Aminah Laparoscopy Center (Benha, Egypt) from June 1, 2018 to October 31, 2021. Forty patients were recruited for this study and counseled on laparoscopic trachelectomy to treat their symptoms after supracervical hysterectomy. Furthermore, cervical biopsy was performed to detect and exclude any malignancy. Histopathological examination of cervical specimens was performed after surgery. Operative details and outcomes were recorded.
Results
The median age of the patients was 42 years (range, 38-47). The median body mass index was 25 years (range, 22- 28). The median interval between hysterectomy and the clinical presentation was 4.40 years (range, 3.58-5.25). Most patients presented with abnormal vaginal discharge (40%) and bleeding (25%). Moreover, a cervical biopsy result revealed stump carcinoma in three cases (7.5%) that were excluded. The median operative time was 210 minutes (range, 170-220). The median blood loss was 270 mL (range, 220-320). Additionally, histopathological examinations revealed that chronic non-specific cervicitis was present in 54.05% of trachelectomy specimens. There were no significant differences between symptomatic and asymptomatic patients regarding operative outcomes, except adhesions, which were more significantly increased in symptomatic patients (P=0.015). Minimal complications, both operative and postoperative, were related to the procedure.
Conclusion
Although the operative time was long and adhesions were common during laparoscopic trachelectomy, the procedure was feasible and safe, with minimal complications.

Keyword

Laparoscopic trachelectomy; Cervical stump carcinoma; Surgical outcomes; Supra-cervical hysterectomy

Figure

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  Fig. 1 Position of ports in laparoscopic trachelectomy (a) 10 mm port at Lee-Hwang point, (b) and (c) 5 mm port at midclavicular line, two fingers above the anterior superior iliac spines.

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  Fig. 2 Cervical stump and bilateral adnexa.

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  Fig. 3 (A) Adhesiolysis of omentum and bowel from lateral pelvic wall and cervical stump. (B) Douglas pouch free of adhesions. (C) Urinary bladder dissected downwards and colpotomizer pushed upwards to delineate the cervix. (D) Excision of the cervix by monopolar energy using hook.

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  Fig. 4 (A) Chronic nonspecific cervicitis; endocervical mucosa with lymphocytic inflammation (×100).(B) Cervical endometriosis; a focus within the cervical stroma containing endometrial glands and stroma (×200). (C) CIN I; nuclear hyperchromasia and pleomorphism involving the lower one third of epithelium (×400). (D) CIN II; nuclear hyperchromasia and pleomorphism involving the lower 2/3rd of the epithelium (×400). CIN, cervical intraepithelial neoplasia.

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  Fig. 5 Correlation matrix showing the correlation coefficients between other variables. Cx, cervical length; BMI, body mass index; Hb, hemoglobin.

Reference

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