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Laparoscopic type C radical hysterectomy and pelvic lymphadenectomy for cervical cancer
This video shows a standardized and reproducible approach to radical hysterectomy. The procedure begins with the dissection of the lateral pelvic spaces in order to identify and isolate the paracervix. After coagulation and division of the round ligament, the surgeon performs a T-shape incision until the psoas muscles to expose the field for the ilio-obturator lymphadenectomy. The paravesical fossa is then dissected in its medial and lateral aspect using the umbilical artery as a landmark. Following the umbilical artery in a ventral to dorsal direction, the surgeon identifies the uterine artery and the paracervix. Using the uterine artery as a landmark of the paracervix, dissection is continued posteriorly developing the Latzko and Okabayashi spaces in order to isolate the paracervix. Once the spaces have been developed, the lymphadenectomy is performed separating the external iliac vessels from the psoas muscle to reach the obturator fossa. During this step, the obturator nerve is identified to avoid injuries and to mark the caudal limit of the lymphadenectomy.
The procedure is carried on with the isolation of the ureter in its anterior aspect between the paracervix and the bladder. To do so, the bladder pillar is identified and the dissection is pursued between its medial and lateral aspect developing the so-called space of Yabuki. The bladder pillar is then transected at the level of the bladder. The rectal pillar is transected at the level of the rectum paying attention to isolate the inferior hypogastric nerve. The paracervix is then cut at the level of the hypogastric vessel and the ureter is unroofed.
The vagina is cut with monopolar energy using a vaginal valve as a guide and the specimen is extracted vaginally.
The vagina is closed with three stitches using an extracorporeal knotting technique.
G Centini, K Afors, J Castellano, C Meza Paul, R Murtada, A Wattiez
Surgical intervention
5 years ago
10900 views
351 likes
0 comments
07:20
Laparoscopic type C radical hysterectomy and pelvic lymphadenectomy for cervical cancer
This video shows a standardized and reproducible approach to radical hysterectomy. The procedure begins with the dissection of the lateral pelvic spaces in order to identify and isolate the paracervix. After coagulation and division of the round ligament, the surgeon performs a T-shape incision until the psoas muscles to expose the field for the ilio-obturator lymphadenectomy. The paravesical fossa is then dissected in its medial and lateral aspect using the umbilical artery as a landmark. Following the umbilical artery in a ventral to dorsal direction, the surgeon identifies the uterine artery and the paracervix. Using the uterine artery as a landmark of the paracervix, dissection is continued posteriorly developing the Latzko and Okabayashi spaces in order to isolate the paracervix. Once the spaces have been developed, the lymphadenectomy is performed separating the external iliac vessels from the psoas muscle to reach the obturator fossa. During this step, the obturator nerve is identified to avoid injuries and to mark the caudal limit of the lymphadenectomy.
The procedure is carried on with the isolation of the ureter in its anterior aspect between the paracervix and the bladder. To do so, the bladder pillar is identified and the dissection is pursued between its medial and lateral aspect developing the so-called space of Yabuki. The bladder pillar is then transected at the level of the bladder. The rectal pillar is transected at the level of the rectum paying attention to isolate the inferior hypogastric nerve. The paracervix is then cut at the level of the hypogastric vessel and the ureter is unroofed.
The vagina is cut with monopolar energy using a vaginal valve as a guide and the specimen is extracted vaginally.
The vagina is closed with three stitches using an extracorporeal knotting technique.
Stepwise radical vaginal trachelectomy: Dargent’s operation
Up to 40% of early cervical cancers are diagnosed in young women who might desire fertility preservation. More than 1,000 cases of Radical Vaginal Trachelectomy (RVT) have been published so far, with over 450 pregnancies achieved. Oncological outcomes of this treatment are totally comparable with the ones obtained with radical hysterectomies for similar size lesions. Additionally, these results are similar or superior when compared to the other routes of trachelectomy.
The procedure is always combined with a laparoscopic pelvic lymphadenectomy to rule out the possibility of lymph node metastases.
This video demonstrates the technique of RVT. Interesting parts of the vaginal steps are shown along with their contemporary laparoscopic views for didactic purposes.
E Leblanc, F Narducci, L Bresson, M Puga
Surgical intervention
5 years ago
3079 views
88 likes
1 comment
09:21
Stepwise radical vaginal trachelectomy: Dargent’s operation
Up to 40% of early cervical cancers are diagnosed in young women who might desire fertility preservation. More than 1,000 cases of Radical Vaginal Trachelectomy (RVT) have been published so far, with over 450 pregnancies achieved. Oncological outcomes of this treatment are totally comparable with the ones obtained with radical hysterectomies for similar size lesions. Additionally, these results are similar or superior when compared to the other routes of trachelectomy.
The procedure is always combined with a laparoscopic pelvic lymphadenectomy to rule out the possibility of lymph node metastases.
This video demonstrates the technique of RVT. Interesting parts of the vaginal steps are shown along with their contemporary laparoscopic views for didactic purposes.
Radical nerve-sparing hysterectomy (type C1)
This video demonstrates a nerve-sparing radical hysterectomy (type C1).
During type C Radical Hysterectomy (RH), the uterus is removed en bloc with its ligaments along with a vaginal margin of 15 to 20mm. The uterosacral ligaments are transected from the level of the rectum and the vesicouterine ligament at the level of the bladder. The ureter is dissected until it enters the bladder. It is mobilized completely to resect the lateral parametrium from the lateral wall.

Radical hysterectomy type C1 implies the preservation of the hypogastric inferior nerve and the bladder branch of the hypogastric plexus during the resection of the parametrium.
During the surgery, the components of the hypogastric plexus are identified: the inferior hypogastric nerve running from the lateral wall of the rectum and the splanchnic nerves from S2-S4. The deep uterine vein is an essential landmark because we can find the first splanchnic nerve underneath it. Consequently, during the resection of the posterior parametrium, the uterosacral ligament can be completely resected while conserving the inferior hypogastric nerve. Division of the lateral parametrium is pursued without including the splanchnic nerves. During the transection of the caudal part of the paracervix and the paracolpium, attention must be paid not to include the vesical branch of the inferior hypogastric plexus that runs parallel to paravaginal vessels.
M Malzoni, A Ruggiero, M Puga
Surgical intervention
6 years ago
8499 views
156 likes
0 comments
20:14
Radical nerve-sparing hysterectomy (type C1)
This video demonstrates a nerve-sparing radical hysterectomy (type C1).
During type C Radical Hysterectomy (RH), the uterus is removed en bloc with its ligaments along with a vaginal margin of 15 to 20mm. The uterosacral ligaments are transected from the level of the rectum and the vesicouterine ligament at the level of the bladder. The ureter is dissected until it enters the bladder. It is mobilized completely to resect the lateral parametrium from the lateral wall.

Radical hysterectomy type C1 implies the preservation of the hypogastric inferior nerve and the bladder branch of the hypogastric plexus during the resection of the parametrium.
During the surgery, the components of the hypogastric plexus are identified: the inferior hypogastric nerve running from the lateral wall of the rectum and the splanchnic nerves from S2-S4. The deep uterine vein is an essential landmark because we can find the first splanchnic nerve underneath it. Consequently, during the resection of the posterior parametrium, the uterosacral ligament can be completely resected while conserving the inferior hypogastric nerve. Division of the lateral parametrium is pursued without including the splanchnic nerves. During the transection of the caudal part of the paracervix and the paracolpium, attention must be paid not to include the vesical branch of the inferior hypogastric plexus that runs parallel to paravaginal vessels.