Robotic-Assisted Laparoscopic Trachelectomy: A Standard Technique

Study Objective: To describe a standard reproducible technique for simple robotic-assisted laparoscopic trachelectomy. Design: Step-by-step demonstration of the technique using videos and pictures (Canadian Task Force classification level 3). Setting: The incidence of trachelectomy after supracervical hysterectomy has been increasing, given the popularity of supra cervical hysterectomy. The most common indication for trachelectomy is symptomatic cyclic bleeding. Trachelectomy can be performed vaginally as well as laparoscopically with or without robotic assistance. This video demonstrates a standard reproducible technique for robotic-assisted trachelectomy in 2 women who underwent previous supracervical hysterectomy with a retained cervix. Interventions: Robotic-assisted laparoscopic trachelectomy using a standard technique is demonstrated in 2 different examples. The steps include opening the vesicocervical peritoneum, creating a bladder flap and pushing the bladder down beyond the vaginal cuff, opening the remnant of the broad ligament and delineating the course of cervical branch of the uterine artery and ureter bilaterally, inserting a uterine manipulator with a colpotomizer under vision, performing desiccation of the cervical branches of the uterine artery, and performing colpotomy and closure of the vaginal cuff. Conclusion: Robotic-assisted laparoscopic trachelectomy is a safe and simple procedure that should be part of all general gynecologists' armamentarium. The described technique is reproducible and efficient and can be adopted for all cases requiring simple trachelectomy. (C) 2017 AAGL. All rights reserved.