Highlights
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TIRRHVC is a technique for treatment of early stage cervical cancer.
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Vaginal cerclage enhances tumor containment.
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The 3-year DFS is 95.5%
Keywords: Tumor containment, Robotic radical hysterectomy, Minimally invasive surgery, Vaginal cerclage, Cervical cancer, Nerve sparing radical hysterectomy
Abstract
This surgical film describes the steps of a novel minimally invasive surgical technique for the treatment of early-stage cervical cancer that prioritizes tumor containment and minimizes tumor seeding. Total Intracorporeal Robotic Radical Hysterectomy with Vaginal Cerclage and without uterine manipulator (TIRRHVC) is a C1 nerve sparing procedure that minimizes tumor seeding by eliminating the use of a uterine manipulator and maximizes tumor containment by placing circumferential sutures distal to the tumor, completely occluding it from the vagina. This surgical film demonstrates the relevant anatomy, dissection techniques and unique steps to accomplish a TIRRHVC, including the use of the robotic third arm for optimal traction and vaginal cerclage for complete circumferential occlusion of the cervical tumor.
This surgical film describes the steps of a novel minimally invasive surgical technique for the treatment of early-stage cervical cancer that prioritizes tumor containment and minimizes tumor seeding. Total Intracorporeal Robotic Radical Hysterectomy with Vaginal Cerclage and without uterine manipulator (TIRRHVC) is a C1 nerve sparing procedure that minimizes tumor seeding by eliminating the use of a uterine manipulator and maximizes tumor containment by placing circumferential sutures distal to the tumor, completely occluding it from the vagina. This surgical film demonstrates the relevant anatomy, dissection techniques and unique steps to accomplish a TIRRHVC, including the use of the robotic third arm for optimal traction and vaginal cerclage for complete circumferential occlusion of the cervical tumor. The patient population, intraoperative outcomes, postoperative outcomes, and oncologic outcomes for the TIRRHVC procedure have previously been reported (Lim et al., 2024).
A 41-year-old female with clinical stage IB2 (2.5 cm), grade 2 squamous cell carcinoma of the cervix underwent a total intracorporeal robotic radical hysterectomy with vaginal cerclage without uterine manipulator. She underwent this procedure successfully with estimated blood loss of 50 cc and no intraoperative or postoperative complications. The steps of the procedure are described in the surgical film, including the novel use of a complete circumferential vaginal cerclage.
Footnotes
Supplementary data to this article can be found online at https://doi.org/10.1016/j.gore.2024.101449.
Appendix A. Supplementary data
The following are the Supplementary data to this article:
References
- Lim L., Slee A., Lim P.C. Feasibility and early oncologic outcomes of Total Intracorporeal robotic radical hysterectomy with vaginal cerclage (TIRRHVC) for the treatment of clinical stage IB cervical cancer: A tumor containment technique. Gynecologic. Oncol. Rep. 2024;101437 doi: 10.1016/j.gore.2024.101437. [DOI] [PMC free article] [PubMed] [Google Scholar]
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