Universität zu Köln

Plaikner, Andrea, Jacob, Anna, Siegler, Kathrin, Schneider, Achim, Ragosch, Volker, Barinoff, Jana and Kohler, Christhardt (2020). Modification of Dargent's radical vaginal trachelectomy to facilitate ureteral dissection: description of technique. Int. J. Gynecol. Cancer, 30 (8). S. 1210 - 1215. LONDON: BMJ PUBLISHING GROUP. ISSN 1525-1438

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Abstract

Objective Radical vaginal trachelectomy is the fertility-preserving surgery for patients with early stage cervical cancer. However, it has not gained widespread approval by gynecologic oncologists because of difficulties in the dissection of the bladder pillars and identification of the ureter during the vaginal portion of the surgery. Method We describe a modification of radical vaginal trachelectomy for easier dissection of the bladder pillar. Following pelvic lymphadenectomy, the vesicovaginal space is widely opened laparoscopically. After identification of the uterine arteries, one should proceed along the course of the arteries laterally and, thus, visualize the overcrossing of the artery with the ureter. The medial aspect of the supraureteric bladder pillar is transected and the ureter marked with vessel loops on both sides close to its entry into the bladder. The lateral portion of the supraureteric bladder pillar remains intact. During the vaginal part of radical vaginal trachelectomy, the ureter may be easily found by grasping the formerly placed vessel loop and dissection of the infraureteric bladder pillar may be done without risk of ureteral injury. Results Between October 2018 and August 2019 our group has performed radical vaginal trachelectomy using this modified ureteral dissection in 12 patients. Median operation time was 239 min (range 127-290) and median blood loss was 25 mL (range 10-100). No intra- or post-operative urologic complication occurred. Median time to normal bladder function was 4 days (range 3-13). Conclusion The vaginal portion of radical vaginal trachelectomy may be simplified using this technique, especially when difficult circumstances such as endometriosis, prior operations, or unusual anatomy in nulliparous women are encountered.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Plaikner, Andrea UNSPECIFIED UNSPECIFIED UNSPECIFIED Jacob, Anna UNSPECIFIED UNSPECIFIED UNSPECIFIED Siegler, Kathrin UNSPECIFIED UNSPECIFIED UNSPECIFIED Schneider, Achim UNSPECIFIED UNSPECIFIED UNSPECIFIED Ragosch, Volker UNSPECIFIED UNSPECIFIED UNSPECIFIED Barinoff, Jana UNSPECIFIED UNSPECIFIED UNSPECIFIED Kohler, Christhardt UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-324748
DOI:	10.1136/ijgc-2020-001478
Journal or Publication Title:	Int. J. Gynecol. Cancer
Volume:	30
Number:	8
Page Range:	S. 1210 - 1215
Date:	2020
Publisher:	BMJ PUBLISHING GROUP
Place of Publication:	LONDON
ISSN:	1525-1438
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language STAGE CERVICAL-CANCER; LAPAROSCOPIC PELVIC LYMPHADENECTOMY; QUALITY-OF-LIFE; HYSTERECTOMY; CARCINOMA; MORBIDITY; OUTCOMES; SURGERY Multiple languages Oncology; Obstetrics & Gynecology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/32474