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Laparoscopic fertility sparing management of cervical cancer.

Facchini C, Rapacchia G, Montanari G, Casadio P, Pilu G, Seracchioli R - Int J Fertil Steril (2014)

Bottom Line: The surgery was successful and she was discharged two days later.The patient underwent a caesarean section at 38 weeks of gestation.Laparoscopic surgery is a minimally invasive approach associated with less pain and faster recovery, feasible even in obese women.

View Article: PubMed Central - PubMed

Affiliation: The Minimally Invasive Gynecological Surgery Unit, Department of Gynecology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.

ABSTRACT
Fertility can be preserved after conservative cervical surgery. We report on a 29-year-old woman who was obese, para 0, and diagnosed with cervical insufficiency at the first trimester of current pregnancy due to a previous trachelectomy. She underwent laparoscopic transabdominal cervical cerclage (LTCC) for cervical cancer. The surgery was successful and she was discharged two days later. The patient underwent a caesarean section at 38 weeks of gestation. Laparoscopic surgery is a minimally invasive approach associated with less pain and faster recovery, feasible even in obese women.

No MeSH data available.


Related in: MedlinePlus

Cervical length with cerclage in situ by transvaginalultrasound.
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Figure 2: Cervical length with cerclage in situ by transvaginalultrasound.

Mentions: A 29-year-old obese woman with body mass index (BMI) of 30.4, para 0, and large for gestationalage (LGA) came to our clinic (S. Orsola-MalpighiHospital, Bologna, Italy), in January 2012 for a shortcervical length evaluation. She had a history of oncological surgery for squamocellular cervical cancertwo years earlier (stage I (T1N0M0)). She underwenta vaginal trachelectomy and laparoscopic pelvic nodedissection in our hospital (S. Orsola-Malpighi Hospital, Bologna, Italy). The follow-up examination was uneventful, and subsequently, she had a spontaneousconception. Transvaginal ultrasound scanning confirmed a single intrauterine pregnancy at 10 weeks ofgestation. The size was consistent with dates and theresult of nuchal translucency screening, performedat 11 weeks’ gestation, was normal. Her cervicallength was <1 cm. Because of a virtually nonexistent cervix, we proposed a laparoscopic transabdominal cervical cerclage (LTCC) that was performed at12 weeks' gestation. Under general anaesthesia, thepatient was placed in dorsal lithotomy position and aFoley catheter was inserted. No vaginal instrumentation was used. The intervention was done with minimal uterine manipulation and minimal dissection. Thevesico-uterine peritoneum was open and the bladderwas dissected off the lower uterine segment bluntly. Itwas pierced the broad ligament medial to the uterinevessels with a laparoscopic suturing device withoutdissecting the uterine vessels. Mersilene band wasplaced at uterus at the level of cervical isthmus, and itwas then knotted against the posterior cervical isthmus (Fig 1). Bladder integrity was preserved. Theoperation lasted 65 minutes. Fetal cardiac activitywas confirmed before and after the procedure. Thepatient was discharged from the hospital 2 dayslater. The follow-up ultrasound during the rest ofher pregnancy was uneventful (Fig 2). She underwent a caesarean section at 38 weeks of gestationbecause of the onset of labour (Fig 3). Intraoperative inspection of the surgical site revealed matureperitoneal tissue covering the tape, without adhesions. The cerclage tape was left in situ at the end ofthe caesarean section for future pregnancies. Birthweight was 3770 g with Apgar scores of 9 at both 1st and 5thminutes and pH was 7.18. The mother and thebaby were discharged 48 hours after.


Laparoscopic fertility sparing management of cervical cancer.

Facchini C, Rapacchia G, Montanari G, Casadio P, Pilu G, Seracchioli R - Int J Fertil Steril (2014)

Cervical length with cerclage in situ by transvaginalultrasound.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3973170&req=5

Figure 2: Cervical length with cerclage in situ by transvaginalultrasound.
Mentions: A 29-year-old obese woman with body mass index (BMI) of 30.4, para 0, and large for gestationalage (LGA) came to our clinic (S. Orsola-MalpighiHospital, Bologna, Italy), in January 2012 for a shortcervical length evaluation. She had a history of oncological surgery for squamocellular cervical cancertwo years earlier (stage I (T1N0M0)). She underwenta vaginal trachelectomy and laparoscopic pelvic nodedissection in our hospital (S. Orsola-Malpighi Hospital, Bologna, Italy). The follow-up examination was uneventful, and subsequently, she had a spontaneousconception. Transvaginal ultrasound scanning confirmed a single intrauterine pregnancy at 10 weeks ofgestation. The size was consistent with dates and theresult of nuchal translucency screening, performedat 11 weeks’ gestation, was normal. Her cervicallength was <1 cm. Because of a virtually nonexistent cervix, we proposed a laparoscopic transabdominal cervical cerclage (LTCC) that was performed at12 weeks' gestation. Under general anaesthesia, thepatient was placed in dorsal lithotomy position and aFoley catheter was inserted. No vaginal instrumentation was used. The intervention was done with minimal uterine manipulation and minimal dissection. Thevesico-uterine peritoneum was open and the bladderwas dissected off the lower uterine segment bluntly. Itwas pierced the broad ligament medial to the uterinevessels with a laparoscopic suturing device withoutdissecting the uterine vessels. Mersilene band wasplaced at uterus at the level of cervical isthmus, and itwas then knotted against the posterior cervical isthmus (Fig 1). Bladder integrity was preserved. Theoperation lasted 65 minutes. Fetal cardiac activitywas confirmed before and after the procedure. Thepatient was discharged from the hospital 2 dayslater. The follow-up ultrasound during the rest ofher pregnancy was uneventful (Fig 2). She underwent a caesarean section at 38 weeks of gestationbecause of the onset of labour (Fig 3). Intraoperative inspection of the surgical site revealed matureperitoneal tissue covering the tape, without adhesions. The cerclage tape was left in situ at the end ofthe caesarean section for future pregnancies. Birthweight was 3770 g with Apgar scores of 9 at both 1st and 5thminutes and pH was 7.18. The mother and thebaby were discharged 48 hours after.

Bottom Line: The surgery was successful and she was discharged two days later.The patient underwent a caesarean section at 38 weeks of gestation.Laparoscopic surgery is a minimally invasive approach associated with less pain and faster recovery, feasible even in obese women.

View Article: PubMed Central - PubMed

Affiliation: The Minimally Invasive Gynecological Surgery Unit, Department of Gynecology, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.

ABSTRACT
Fertility can be preserved after conservative cervical surgery. We report on a 29-year-old woman who was obese, para 0, and diagnosed with cervical insufficiency at the first trimester of current pregnancy due to a previous trachelectomy. She underwent laparoscopic transabdominal cervical cerclage (LTCC) for cervical cancer. The surgery was successful and she was discharged two days later. The patient underwent a caesarean section at 38 weeks of gestation. Laparoscopic surgery is a minimally invasive approach associated with less pain and faster recovery, feasible even in obese women.

No MeSH data available.


Related in: MedlinePlus