This is a step-by-step demonstration of a uterine artery sparing robotic-assisted radical trachelectomy. In this procedure, the retroperitoneum was entered within a triangle outlined by the round ligament, infundibulopelvic ligament and external iliac vessels. Pararectal and paravesical spaces were developed. Ureterolysis was started at the pelvic brim and ureter was freed off its peritoneal as well as uterine artery attachments. The paracervical tunnels were unroofed which allowed the ureter to be completely free in the retroperitoneum. The uterine arteries were skeletonized starting from their origin at hypogastric bifurcation, over the ureter, and to their entry point into the uterus. Once parametrium and paracolpos were resected, bilateral uterosacral ligaments were skeletonized and rectovaginal space was developed. Circumferential colpotomy was performed approximately 2 cm below cervicovaginal junction which defined the vaginal margin. Upper margin of the trachelectomy specimen was 1 cm distal to entrance of uterine arteries into the cervix. Specimen was removed through vagina and a cerclage was placed into upper cervix/ lower uterine segment. The procedure was completed vaginally with utero-vaginal reconstruction.
Elena Ratner, M.D.