Robotic single-port radical trachelectomy using the da Vinci SP surgical system = Robotic single-port radical trachelectomy using the da Vinci SP surgical system

다국어 초록 (Multilingual Abstract)

Objective: 3. Demonstrate a new instrument, technique or procedure
Target: 2. Adanced practicioners
Methods: A 41-year-old woman was diagnosed with cervical cancer. Pelvic lymph node metastasis was suspected on PET-CT. The patient wanted to preserve fertility. To confirm the possibility to preserve fertility and exact stage, single-port laparoscopic pelvic sentinel LN biopsy and large loop excision of transformation zone of the cervix was performed. Pathology showed no metastasis in bilateral pelvic sentinel LN, the largest dimension was 22mm, and the cell type was invasive squamous cell carcinoma. A week later, robot-assisted radical trachelectomy was performed. A single 2.5 cm umbilical incision was made and a multichannel single-port entry system (Uni-Port, Dalim, South Korea) was installed. Fenestrated bipolar forceps were loaded on the 1st arm, cardiere forceps on the 2nd arm, and monopolar curved scissors on the 3rd arm, respectively. The ureter was dissected free from the pelvic peritoneum, and the uterine artery was free from its connection in the retroperitoneum. Using clips and scissors, the proximal portion of the uterine artery was ligated and cut. The patient had no lesions left in the cervix due to previous LEEP, so the cervix was resected using a manipulator. The cervix was amputated from just below the site where the ascending branches of the uterine artery enters the uterus. As a result of checking the frozen section pathology, the margin was clean. A cerclage is performed in the isthmic portion of the uterus. The uterus was then reattached to the vagina with barbed sutures.
Results: The docking time was 5 minutes, the console time was 135 minutes, and the total operation time was 246 minutes. The estimated blood loss was 100mL and the change in hemoglobin level was 1.2 g/dL. The post-operative hospital stay was 3 days. There was no metastatic lymph node on the final pathology reports and FIGO stage was IB2 of cervical cancer.
Conclusion: Single-port robotic platform provides for a new approach to robotic trachelectomy as a feasible and suitable alternative surgical technique.