#220 Robotic Assisted TYPE II RADICAL HYSTERECTOMY FOR EARLY CERVICAL CA…- Dr. Rohit Ranade

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:

FULL TITLE: VIDEO DEMONSTRATION OF ROBOTIC ASSISTED TYPE II RADICAL HYSTERECTOMY FOR EARLY CERVICAL CANCER WITH VAGINAL CUFF CLOSURE USING ENDOSCOPIC STAPLER BEFORE COLPOTOMY

INTRODUCTION: Minimally invasive surgery decreases postoperative morbidity after radical hysterectomy (RH) for early-stage cervical cancer. However, studies reported lower survival and higher recurrence rates as compared to open surgery, which maybe due to tumour spillage into the abdominal cavity during vaginal colpotomy or use of a uterine manipulator. This surgical film aims to present a methodical step-by-step approach for robotic radical hysterectomy with added steps for preventing tumour spillage.

DESCRIPTION: A 48-year-old multiparous lady underwent loop electrosurgical excision procedure (LEEP) for CIN III (Cervical Intraepithelial Neoplasia) which was reported as well differentiated squamous cell carcinoma. There was no visible lesion on clinical examination or imaging. Here is an account of the steps of surgery-

• Creation of retroperitoneal spaces

• Ureterolysis

• Transection of right uterine artery

• Transection of right infundibulopelvic and round ligaments

• Bladder mobilization

• Similar steps on opposite side

• Development of Rectovaginal space

• Dissection of ureters in ureteric tunnel

• Parametrectomy

• Vaginal cuff sealed using Endoscopic stapler

• Sealed distal edge opened and specimen delivered vaginally

• Pelvic lymph node dissection

• Vault closure

CONCLUSION: Robotic-assisted radical surgery is a safe and precise technique in the treatment of cervical cancer, with clear definition of anatomical spaces. Vaginal closure using endoscopic stapler to seal the vagina before colpotomy is an effective and feasible way to prevent dissemination of tumor cells intra-peritoneally and can improve oncological outcomes like rates of recurrence and survival.

See more at: https://vattikutifoundation.com/videos/