Fertility Preserving Robotic Radical Trachelectomy in a 16year-old patient with Cervical Embryonal Rhabdomyosarcoma – FESCH.TV

Fertility Preserving Robotic Radical Trachelectomy in a 16year-old patient with Cervical Embryonal Rhabdomyosarcoma & FESCH.TV:

Background: Embryonal rhabdomyosarcoma (RMS) of the uterine cervix is a rare malignancy and mostly affects children and young adults. Radical trachelectomy is a reasonable option for select patients with early-stage cervical RMS.
Objective: To demonstrate the surgical steps of the procedure in a 16-year-old patient with stage 1B1 cervical RMS measuring 1.7 cm. stage IB1.
Design: A step-by-step explanation of the procedure with surgical video footage.
Key-Interventions:
1. Bilateral retroperitoneal dissection with bilateral complete ureterolysis.
2. Bilateral sentinel retroperitoneal lymph node dissection.
3. Dissection of the pararectal and paravesical spaces
4. The uterine vessels are taken at the origin and the parametrial tissues are mobilized
5. The bladder is mobilized towards the mid vagina
6. The pararectal space is developed and the rectum is mobilized towards the mid vagina
7. The uterosacral ligaments are taken 2 cm from their insertion into the cervix
8. Circumferential vaginotomy with a 2 cm margin from the cervix.
9. The cervix is separated from the lower uterine segment at the level of the internal l os.
10. The radical trachelectomy specimen is sent to frozen section to assess the uterine margin.
11. The uterus is reapproximated to the upper 2/3 of the vagina in a circumferential fashion.
12. Placement of abdominal cerclage using Mersiline tape suture which is placed at the level of the lower uterine segment and tied posteriorly.
Results: A 16-year-old patient successfully underwent fertility preserving robotic radical trachelectomy for the treatment of stage IB1 cervical RMS. All surgical resection margins were negative on final pathology. Sentinel lymph nodes showed no evidence of metastatic disease. She went on to complete systemic chemotherapy and did not require adjuvant radiation therapy. Post-treatment surveillance imaging showed no disease recurrence.
Conclusions: Robotic Radical Trachelectomy is a reasonable surgical option for select patients with early-stage cervical RMS.