Department of Gynecologic Oncology, Cancer Institute Hospital, Tokyo, Japan.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
J Gynecol Oncol. 2023 May;34(3):e27. doi: 10.3802/jgo.2023.34.e27. Epub 2022 Dec 19.
The Laparoscopic Approach to Cervical Cancer (LACC) trial demonstrated that minimally invasive radical hysterectomy was inferior to the open approach [1]; this unexpected result could be attributed to the spillage of cancer cells [2]. Following the LACC trial, laparoscopic radical hysterectomy without an intrauterine manipulator upon completion of a vaginal cuff closure became the new standard treatment method [3]. However, the lack of intrauterine manipulator results in poor visualization and inadequate paracervical tissue resection. This study describes the no-look no-touch technique to address this difficulty. The core procedures in our no-look, no-touch laparoscopic radical hysterectomy are: (Step 1) Creation and closure of a vaginal cuff; (Step 2) Manipulation of the uterus without an intra-uterine manipulator; and (Step 3) Exposure of the paracervical tissues by the suspension technique. The patient eligibility for our procedure is as follows: 1) previously untreated cervical cancer (those who underwent diagnostic conization could be included); 2) clinical stage IA2, IB1, IB2, and IIA1 based on the 2018 International Federation of Gynecology and Obstetrics staging system; 3) histologically confirmed cervical cancer, including squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma. The important indication for this procedure is in cases where the tumor is less than 4 cm in diameter. We previously reported that our no-look no-touch technique enables smooth performance of laparoscopic radical hysterectomy without worsening oncologic outcomes [4]. According to a recent systematic review and meta-analysis [5], minimally invasive radical hysterectomy with vaginal cuff closure is a safe treatment option; however, it involves a steep learning curve, which has impeded its increased application. This video will hopefully make minimally invasive radical hysterectomy with protective maneuvers against cancer cell spillage more accessible. Based on our experiences, we propose that our transvaginal cervical tumor-concealing no-look no-touch technique will mitigate the risk of surgical spill of tumor cells during minimally invasive radical hysterectomy. The informed consent for use of this video was taken from the patient.
腹腔镜宫颈癌根治术（LACC）试验表明，微创根治性子宫切除术不如开放手术[1]；这一意外结果可能归因于癌细胞的外溢[2]。LACC 试验后，完成阴道残端关闭时没有宫内操作器的腹腔镜根治性子宫切除术成为新的标准治疗方法[3]。然而，没有宫内操作器会导致子宫可视化不良和宫颈旁组织切除不足。本研究描述了一种无需直视、无需接触的技术来解决这一难题。我们的无接触、无接触腹腔镜根治性子宫切除术的核心步骤如下：（步骤 1）阴道残端的创建和关闭；（步骤 2）在没有宫内操作器的情况下操作子宫；和（步骤 3）通过悬挂技术暴露宫颈旁组织。我们的手术适用于以下患者：1）未经治疗的宫颈癌（包括接受诊断性宫颈锥切术的患者）；2）根据 2018 年国际妇产科联合会分期系统，临床分期为 IA2、IB1、IB2 和 IIA1；3）组织学证实的宫颈癌，包括鳞状细胞癌、腺癌和腺鳞癌。该手术的重要适应证是肿瘤直径小于 4cm 的病例。我们之前报道过，我们的无接触技术能够在不影响肿瘤学结果的情况下顺利进行腹腔镜根治性子宫切除术[4]。根据最近的一项系统评价和荟萃分析[5]，阴道残端关闭的微创根治性子宫切除术是一种安全的治疗选择；然而，它涉及陡峭的学习曲线，这阻碍了它的广泛应用。这个视频有望使微创根治性子宫切除术在防止癌细胞外溢方面的保护操作更加普及。根据我们的经验，我们提出，我们的经阴道宫颈肿瘤隐匿无接触无接触技术将降低微创根治性子宫切除术中肿瘤细胞手术外溢的风险。使用本视频已获得患者的知情同意。
