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Laparoscopic type C radical hysterectomy and pelvic lymphadenectomy for cervical cancer
Epublication WebSurg.com, Oct 2014;14(10). URL: http://websurg.com/doi/vd01en4370
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.