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Explore Laparoscopic Radical Hysterectomy (Type C1) | Nerve-Sparing Technique Without Uterine Manipulator with 3,019 views, 239 likes, and 0 comments. Experience the impact of this video content that has captured audience attention.

The video demonstrates a laparoscopic type C1 radical hysterectomy with bilateral salpingo-oophorectomy and systematic pelvic lymphadenectomy. Key technical highlights include: • No use of a uterine manipulator • External uterine manipulation via Palmer’s point • Complete ureteral dissection, including the Morrow space • Nerve-sparing parametrectomy (Type C1) • Vaginal closure over the cervix to prevent tumor spillage • Extracorporeal vaginal cuff closure During surgery, a vaginal uterine manipulator is strictly avoided. Instead, an additional 5 mm port is placed at Palmer’s point, and the uterus is manipulated externally through this port. Following systematic lymphadenectomy and development of the surgical spaces, the uterine artery and vein are clipped and transected at their origin. The ureter is fully dissected along its course, including the Morrow space, and lateralized. The parametrium is resected without extending below the level of the deep uterine vein. The anterior vesicouterine ligament is transected. The rectum is mobilized posteriorly, and the bladder is dissected off the vagina anteriorly. After bladder dissection, the procedure is continued via the vaginal route. The anterior and posterior vaginal walls are elevated and tightly sutured over the tumor-bearing cervix to ensure complete coverage. The procedure is then resumed laparoscopically, and a colpotomy is performed. The specimen is removed. Finally, the vaginal cuff is closed using an extracorporeal suturing technique, and hemostasis is achieved. No drain was inserted. The treatment decision was laparoscopic radical hysterectomy with bilateral salpingo-oophorectomy (BSO) and systematic pelvic lymphadenectomy. Following the publication of the LACC trial (Ramirez et al., 2018), the use of minimally invasive surgery in cervical cancer became significantly restricted. However, subsequent studies, including SUCCOR (Chiva et al., 2020), CIRCOL (Baiocchi et al., 2021), and MEMORY (Leitao et al., 2022), suggest that a laparoscopic approach may still be considered in carefully selected patients with tumors smaller than 2 cm, particularly in experienced centers. Current NCCN and ESGO guidelines similarly suggest that minimally invasive surgery may be considered in carefully selected patients with tumors smaller than 2 cm, particularly in experienced centers. To minimize the risk of intraoperative tumor dissemination, the following measures were implemented: 1. A uterine manipulator was not used. 2. After vaginal mobilization, the anterior and posterior vaginal walls were approximated and sutured over the cervix to ensure complete coverage of the exophytic tumor. The patient was discharged on postoperative day 3 without any complications. Final pathology revealed no lymph node metastasis and no parametrial involvement. The closest vaginal surgical margin was at least 15 mm from the tumor. Tumor size was 21 × 15 × 18 mm. Lymphovascular space invasion (LVSI) was present, and stromal invasion was superficial. No adjuvant therapy was administered. At 40 months of follow-up, there was no evidence of disease recurrence. TÜRKÇE Erken evre serviks kanseri için uygulanan sistematik pelvik lenfadenektomi ile birlikte laparoskopik tip C1 radikal histerektomi. Bu video, laparoskopik tip C1 radikal histerektomi, BSO ve sistematik pelvik lenfadenektomi’yi içermektedir. Cerrahi esnasında kesinlikle vaginal yerleşimli bir uterin manipulatör kullanılmıyor. Bunun yerine palmer noktasından ektra bir 5 mmlik port açılıyor ve uterus bu şeklide manipule ediliyor. Sistematik lenfadenektomi ve cerrahi boşlukların oluşturulmasını takiben, uterin arter ve ven çıktığı yerden kliplenip kesiliyor. üreter, boydan boya (morrow boşluğu da dahil) diseke edilip lateralize ediliyor. Parametriumlar, derin uterin ven seviyesinin aşağısına inmeden eksize ediliyor. Anterior vesicouterin ligaman kesiliyor. Rektum, posterior vagenden düşürülüyor. Mesane ise, önde anterior vagenden düşürüldükten sonra, vaginal pozisyona geçilip, vagen ön ve arka duvarları kaldırılıp tümörlü serviks üzerine sıkıca dikiliyor. Sonrasında tekrar laparoskopiye dönülüyor ve vagen kesilerek piyes dışarı alınıyor. Vagen ektrakorporeal sütürler ile kapatılıp, kanama kontrolü ile cerrahiye son veriliyor. Batına dren yerleştirilmiyor. Hasta postoperatif 3. günde herhangi bir komplikasyon olmaksızın taburcu edilmiştir. #radicalhysterectomy #laparoscopicsurgery #gynecologiconcology #cervicalcancer #minimallyinvasivesurgery #surgicaltechnique #pelviclymphadenectomy #laparoscopy #oncologicsurgery #nervesparing #surgicaleducation #endoscopicsurgery #surgeryvideo #typeC1radicalhysterectomy #laparoscopicradicalhysterectomy #deeputerinevein #uterineartery #obliteratedumbilicalartery #uretery #morrowspace #pararectalspace #paravesicalspace #rectovaginalspace #vesicovaginalspace #hypogastricartery #externaliliacartery #externaliliacvein #superiorvesicalartery #typeC1hysterectomy

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