#182 R A RADICAL PARAMETRECTOMY WITH BILATERAL PELVIC L N D IN CERVICAL CANCER

This is one of the 2023 KS International Innovation Awards videos selected for inclusion in the Vattikuti Foundation – ORSI Humans on the Cutting Edge of Robotic Surgery Conference, October 6, 7 & 8, 2023 in Ghent, Belgium. Posting does not imply that is has been selected as a Finalist, just that the content will be discussed at the Conference.

From the entry: Dr. Abhirami G R

Abstract: ROBOTIC ASSISTED RADICAL PARAMETRECTOMY WITH BILATERAL PELVIC LYMPH NODE DISSECTION IN CERVICAL CANCER Dr Abhirami GR, Dr Shruthi Dhevi RS, Dr Shree Bharathi, Dr Monica Saraswat, Dr Rohit Raghunath Ranade Department of Gyneconcology and Robotic surgery, Narayana health city, Bangalore, India

BACKGROUND The diagnosis of invasive cervical cancer after hysterectomy for non-malignant indications is very common. For patients presenting with incidental diagnosis of early stage invasive cervical cancer (FIGO stages 1A1-1B2), two possible strategies can be proposed: Adjuvant radiation therapy with no tumour target or Radical parametrectomy with upper vaginectomy and pelvic lymph node dissection. This video is to demonstrate Robotic assisted radical parametrectomy with bilateral pelvic lymph node in a case of 46 years, multiparous lady with cervical cancer – post hysterectomy for abnormal uterine bleeding.

PROCEDURE Surgery was initiated by port placement. Intra-operatively adhesions were noted between vault, left lateral pelvis wall and sigmoid colon. Adhesions were released carefully. In this procedure, the crucial step is to create the avascular pelvic spaces and ureteric dissection. Bilateral retroperitoneal space was created. Iliac vessels and ureters were identified. Paravesical and pararectal space were created on both sides. Pre-rectal was created isolating the uterosacral ligaments. Bladder was dissected inferiorly upto middle third of vagina. Ureteric dissection is carried out upto its entry into bladder. Radical parametrectomy with upper vaginectomy was done. Bilateral pelvic node dissection was done. Post-operative period was uneventful. Histopathology examination was reported as no residual disease with negative lymph. Hence she is on regular follow-up.

CONCLUSION Radical parametrectomy presents with lower complications, making it the preferred approach to treat younger patients, when compared to radiation therapy. Minimally invasive procedure like robotic assisted surgery is feasible and effective than the traditional laparotomy for performing radical parametrectomy.

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