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Learning Curve Analysis of Intracorporeal Cuff Suturing during Robotic Single-Site Total Hysterectomy
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S1–S44 13
Open Communications 1 - Robotics (11:36 AM - 11:41 AM)
Single-Site Hysterectomy: Robotic Versus Laparoscopic Gungor M,1 Dursun P,2 Kahraman K,1 Ozbasli E,1 Genim C.3 1Obstetrics and Gynecology, Acibadem University School of Medicine, Istanbul, Sariyer, Turkey; 2Obstetrics and Gynecology, Baskent University School of Medicine, Ankara, C¸ ankaya, Turkey; 3Obstetrics and Gynecology, Acibadem Maslak Hospital, Istanbul, Sariyer, Turkey Study Objective: To evaluate the feasibility, efficacy and safety robotic single-site hysterectomy and laparoscopic single-site hysterectomy, and to compare the perioperative parameters of the two single-port surgery systems. Design: Retrospective, case-control study. Setting: Double-institution, university hospitals. Patients: Twelve patients underwent robotic single-site hysterectomy and 19 patients underwent laparoscopic single-site hysterectomy. Intervention: Single-site robotic hysterectomy and single-site laparoscopic hysterectomy Measurements and Main Results: All procedures were successfully performed via a single port and there were no conversions to conventional multi-port laparoscopy, multi-port robotic, open surgery, or vaginal surgery. There were no statistically differences noted between the two groups in terms of mean age (55,85,1 vs. 54,69,4; P 0.69) and mean body-mass index (27,75,4 vs. 27,45,3; P: 0.87) In the robotic group, the mean docking time was 5.8 min1.5. The total operative time was 87.512,3 min. in robotic group, and 10435,7 min. in laparoscopic group (P 0.14). The median estimated blood loss was 40 ml in the robotic group and 50 ml in the laparoscopic group (P 0.48). No operative and post-operative complications occurred in the two groups. The median time to discharge from the hospital was one day for both techniques. Conclusion: Robotic single-site and laparoscopic single-site are feasible and safe techniques for hysterectomy operation in terms of operative time, rates of conversion to laparotomy or multiport laparoscopy/robotic rates, complication, and postoperative results. The possible benefits of robotic single-site surgery compared with conventional laparoscopy should be evaluated in further randomized controlled studies. 14
Open Communications 1 - Robotics (11:42 AM - 11:47 AM)
Evaluation of Safety of Same Day Discharge in Patients Who Underwent Minimally Invasive Myomectomy Zaritsky E, Alton K, Yamamoto M. Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland, California Study Objective: To evaluate readmission rates and urgent care utilization by patients discharged home the same day following minimally invasive myomectomy (MIM). Design: This is a descriptive case series of women who underwent same day discharge after MIM via laparoscopic and robotic approach who were followed for readmission rates at 48 hours and 3 months after discharge. Setting: Managed care setting at Kaiser Permanente Northern California (KPNC) medical centers. Patients: Premenopausal female patients desiring uterine preservation who underwent MIM for leiomyomas. Intervention: Minimally invasive myomectomy (MIM) via laparoscopic or robotic approach with discharge home the same day as surgery. Measurements and Main Results: A retrospective chart review was performed on MIM cases performed from January 2011 to December 2013. Multivariate logistic regression calculations were used to compare study readmission rates to a reference readmission rate of 4% (published previously for same day discharge of laparoscopic hysterectomy).Among the 400 cases reviewed, preliminary data showed that 90% of MIM patients were discharged the same day as their surgery. The most common indication for admission were pain control and nausea/vomiting. Of the patients discharged home the same day, readmission rates were 0.5% and 1.5% at 48 hours and 3 months,
S5
respectively. The most common reasons for readmission were pain, nausea/vomiting and wound infection. Less than 2% of patients presented for emergency or urgent care within 48 hours, most commonly for nausea or vomiting, pain, and urinary retention. Median myoma weight was 150 gm, median blood loss was 100 ml, and median surgical time was 200 minutes. Conclusion: Same day discharge after laparoscopic or robotic myomectomy was found to have a low readmission rate and low healthcare utilization use in the immediate postoperative period. Same day discharge appears to be a safe option for healthy patients undergoing minimally invasive myomectomy. 15
Open Communications 1 - Robotics (11:48 AM - 11:53 AM)
Expanded Robotic Training and Education of Residents and Faculty Surgeons Using Dual Console Robotic Platforms Utilizing Aviation Safety Trans Cockpit Responsibility Gradient Comparisons Breen MT. Ob/Gyn Minimally Invasive and Robotic Surgery, UT Southwestern Ob/Gyn Austin, Austin, Texas Study Objective: The uniqueness of the operating console has created a surgical environment not ever seen in gynecological surgical training. Complexities of learning in the real time operative theater are much more closely modeled by aviation research of cockpit interactions.Objectives of this sudy to contrast and compare single versus dual consoles in a robotic training and learning environment. Design: Survey methodology using a cross sectional survey (Lickert Scale) utilizing Mann Whitney test for result analysis. Survey for both trainers and learners exploring and contrasting ease of instruction,clarity of communication,perception of safety,anxiousness in teaching,anxiousness in learning,perceptions on single console versus dual console,behavioral interaction perceptions. Setting: Dynamic Robotic Training program in a 20 resident Ob Gyn program with 6 robotic trained faculty.High volume of resident and faculty participation on both dual and single console platforms. Patients: Both private patient and staff service patients utilized.These include benign gynecological and gyn oncological cases. Measurements and Main Results: Preference for learning on dual over single console. Preference for training on dual over single console. Perception of safety by learner on dual over single console. Perception of safety by trainer on dual over single console. Acknowledgement of trans console gradient across dual console as compared to single console environment. No perception of more ‘‘near misses’’ with single console over dual console. No perception dual console resulted in better surgical outcomes or superior surgical technique than single console. Conclusion: Dual console training methods have some unique inter personal trainee/trainer dynamics not encountered in traditional open or laparoscopic surgery. Trainees and trainers prefer dual over single console. No perception of better outcomes in dual versus single console.Similiarities between aviation trans cockpit interactions and dual console interactions are percieved.. The role of dual console in robotic training is percieved as beneficial in the training environment. 16
Open Communications 1 - Robotics (11:54 AM - 11:59 AM)
Learning Curve Analysis of Intracorporeal Cuff Suturing during Robotic Single-Site Total Hysterectomy Akdemir A,1 Zeybek B,1 Ozgurel B,2 Oztekin MK,1 Sendag F.1 1Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Bornova, Turkey; 2Department of Actuarial Sciences, Yasar University, Izmir, Bornova, Turkey Study Objective: To analyze the learning curve of intracorporeal cuff suturing during robotic single-site total hysterectomy. Design: Retrospective design.
S6
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S1–S44
Setting: University Hospital. Patients: Twenty-four patients with benign indications of hysterectomy. Intervention: Twenty-four patients who underwent robotic single-site total hysterectomy for benign indications were included in the study. Surgical procedures were performed using the single-site platform of the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA). All vaginal cuffs were closed intracorporeally using semi-rigid single-site instruments. Measurements and Main Results: An exponential learning curve technique was used to analyze the two learning curves. The first curve included all of the cases (n=24) and analyzed the entire learning process. In the second analysis, we excluded the initial 4 cases (n=20) because of a change in the type of suture needle after the 4th case, and we only analyzed the learning process of the standard technique. The overall mean vaginal cuff closure time was 23.2 7 minutes. The first learning curve (n=24) plateaued after the 14th case, and the second learning curve (n=20) plateaued after the 10th case.
Table 1 Patient characteristics and surgical outcomes. Median
Range
49.5 28.5 5.5 74.5 25 98.5 22.5 192.5 0 0 0 0
40 - 61 21.7 - 34.2 3-10 60-160 16-41 71-183 7-120 65 - 520
18
Laparoscopic Anterior Exenteration with IntraCorporeal Uretero-Sigmoidostomy Joshi S, Puntambekar SS, Kumar S, Galgali S, Puntambekar SP. Galaxy Care Laparoscopy Institute, Pune, Maharashtra, India In advanced pelvic cancers laparoscopy has been established a one of the modalities for doing anterior exenteration. The problem is not only the advanced procedure, but urinary diversion. There are various diversions available. Continent neo-bladder is not possible in post radiotherapy and post chemotherapy cases in female. the rest of the urinary diversions have an abdominal stoma. In our country stomas are not well accepted. Thus ureterosigmoidostomy is the best option. If this can be done laparoscopically,then the morbidity would be less. In the last 10 years we have done 40 anterior exenterations with uretero-sigmoidostomy. Though hyerchloremic acidosis is a known complication, the biochemical alterations are not so much to require hospitalisation. We present our technique of Laparoscopic anterior exenteration with intra-corporeal ureterosigmoid. 19
Age (yrs) BMI (kg/m2) Docking time (minutes) Console time (minutes) Cuff closure time (minutes) Operating time (minutes) EBL(ml) Uterine weight (gr) Intraoperative complication (n) Postoperative complication (n) Blood transfusion (n) Conversion to laparoscopy/ laparotomy (n) Hospital stay (days)
1
Conclusion: An experienced robotic surgeon required approximately 10 cases to achieve proficiency in intracorporeal cuff suturing during robotic single-site total hysterectomy. Novel instruments that create perfect triangulation are needed to overcome the current challenges of suturing and shorten the operating time.
17
Video Session 1 - Oncology (11:00 AM - 11:06 AM)
Single Port Sentinel Lymph Node Biopsy in Endometrial Cancer Sinno AK, Fader AN, Scheib S, Tanner EJ. The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, Maryland Endometrial cancer (EC) is the most common gynecologic malignancy. Initial therapy includes total hysterectomy plus or minus lymphadenectomy. Sentinel lymph node (SLN) biopsy has been proposed as a way to improve detection rates of EC and minimize morbidity of lymphadenectomy. Single institution data suggest that the SLN can accurately predict overall lymph node status in 92% of cases when used as part of a comprehensive protocol. Single port laparoscopy has been described for use in EC but has not been widely adopted despite possible advantages. Robotic surgery can potentially overcome the counterintuitive and opposite hand-instrument movements that have contributed to a steep learning curve in laparoscopic single site surgery. We present the first case of robotic single site hysterectomy with SLN biopsy and near infrared imaging guidance performed in EC in an effort to demonstrate that lymph node sampling is feasible with this platform.
Video Session 1 - Oncology (11:07 AM - 11:13 AM)
Video Session 1 - Oncology (11:14 AM - 11:20 AM)
Laparoendoscopic Single-Site Radical Trachelectomy Using Conventional Laparoscopic Instruments: A Case Report Chung D,1 Kim SW.2 1Department of Obstetrics and Gynecology, Yonsei University Wonju College of Medicine, Wonju, Kangwon, Republic of Korea; 2Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Republic of Korea Recently, we have experienced a case of laparoendoscopic single-site radical trachelectomy with bilateral pelvic lymph node dissection and para-aortic lymph node dissection using conventional laparoscopic instruments. A 29 year-old unmarried woman who was clinically diagnosed cervical cancer, FIGO stage IB1 was operated under laparoendoscopic single-site approach, using a transumbilical, home-made surgical glove port system. The procedure was performed through a 1.7cm umbilical incision with a single multichannel port system consisting of a wound retractor, a surgical glove, and two 5-mm and one 12mm trocars. The procedure was completed successfully in 371min and estimated blood loss was 320cc. No severe intraoperative and postoperative complication occurred, except 6.7cm sized lymphocele which was found on day 11 and drained. The patient has been followed up for 18 months without any evidence of recurrence. 20
Video Session 1 - Oncology (11:21 AM - 11:27 AM)
Laparoscopic Radical Trachelectomy in a Pregnant Patient with Invasive Cervical Cancer at the Second Trimester Hua K, Yi X. Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China This video is to show the first case of laparoscopic radical trachelectomy in a young pregnant patient with cervical cancer FIGO stage IB1 at the second trimester. During the procedure, pelvic lymph nodes were removed completely and sent for frozen section. The result was reported as negative. Then the excised cervix was removed and sent for frozen section. After a negative endocervical margin was confirmed on frozen section, the cervical stump were closed and the upper vagina sutured. It took us about 6 hours to finish the procedure, no intraoperative complications occurred and blood loss was 400ml. The patient delivered baby at 34.2 week’s gestation. After one more year’s follow-up, both the mother and infant were healthy. Compared to the abdominal and vaginal radical trachelectomy, laparoscopic radical trachelectomy provided a wider and amplified view of surgical fields, and lower disturbance to the mobile of uterus.
Open Communications 1 - Robotics (11:36 AM - 11:41 AM)
Single-Site Hysterectomy: Robotic Versus Laparoscopic Gungor M,1 Dursun P,2 Kahraman K,1 Ozbasli E,1 Genim C.3 1Obstetrics and Gynecology, Acibadem University School of Medicine, Istanbul, Sariyer, Turkey; 2Obstetrics and Gynecology, Baskent University School of Medicine, Ankara, C¸ ankaya, Turkey; 3Obstetrics and Gynecology, Acibadem Maslak Hospital, Istanbul, Sariyer, Turkey Study Objective: To evaluate the feasibility, efficacy and safety robotic single-site hysterectomy and laparoscopic single-site hysterectomy, and to compare the perioperative parameters of the two single-port surgery systems. Design: Retrospective, case-control study. Setting: Double-institution, university hospitals. Patients: Twelve patients underwent robotic single-site hysterectomy and 19 patients underwent laparoscopic single-site hysterectomy. Intervention: Single-site robotic hysterectomy and single-site laparoscopic hysterectomy Measurements and Main Results: All procedures were successfully performed via a single port and there were no conversions to conventional multi-port laparoscopy, multi-port robotic, open surgery, or vaginal surgery. There were no statistically differences noted between the two groups in terms of mean age (55,85,1 vs. 54,69,4; P 0.69) and mean body-mass index (27,75,4 vs. 27,45,3; P: 0.87) In the robotic group, the mean docking time was 5.8 min1.5. The total operative time was 87.512,3 min. in robotic group, and 10435,7 min. in laparoscopic group (P 0.14). The median estimated blood loss was 40 ml in the robotic group and 50 ml in the laparoscopic group (P 0.48). No operative and post-operative complications occurred in the two groups. The median time to discharge from the hospital was one day for both techniques. Conclusion: Robotic single-site and laparoscopic single-site are feasible and safe techniques for hysterectomy operation in terms of operative time, rates of conversion to laparotomy or multiport laparoscopy/robotic rates, complication, and postoperative results. The possible benefits of robotic single-site surgery compared with conventional laparoscopy should be evaluated in further randomized controlled studies. 14
Open Communications 1 - Robotics (11:42 AM - 11:47 AM)
Evaluation of Safety of Same Day Discharge in Patients Who Underwent Minimally Invasive Myomectomy Zaritsky E, Alton K, Yamamoto M. Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland, California Study Objective: To evaluate readmission rates and urgent care utilization by patients discharged home the same day following minimally invasive myomectomy (MIM). Design: This is a descriptive case series of women who underwent same day discharge after MIM via laparoscopic and robotic approach who were followed for readmission rates at 48 hours and 3 months after discharge. Setting: Managed care setting at Kaiser Permanente Northern California (KPNC) medical centers. Patients: Premenopausal female patients desiring uterine preservation who underwent MIM for leiomyomas. Intervention: Minimally invasive myomectomy (MIM) via laparoscopic or robotic approach with discharge home the same day as surgery. Measurements and Main Results: A retrospective chart review was performed on MIM cases performed from January 2011 to December 2013. Multivariate logistic regression calculations were used to compare study readmission rates to a reference readmission rate of 4% (published previously for same day discharge of laparoscopic hysterectomy).Among the 400 cases reviewed, preliminary data showed that 90% of MIM patients were discharged the same day as their surgery. The most common indication for admission were pain control and nausea/vomiting. Of the patients discharged home the same day, readmission rates were 0.5% and 1.5% at 48 hours and 3 months,
S5
respectively. The most common reasons for readmission were pain, nausea/vomiting and wound infection. Less than 2% of patients presented for emergency or urgent care within 48 hours, most commonly for nausea or vomiting, pain, and urinary retention. Median myoma weight was 150 gm, median blood loss was 100 ml, and median surgical time was 200 minutes. Conclusion: Same day discharge after laparoscopic or robotic myomectomy was found to have a low readmission rate and low healthcare utilization use in the immediate postoperative period. Same day discharge appears to be a safe option for healthy patients undergoing minimally invasive myomectomy. 15
Open Communications 1 - Robotics (11:48 AM - 11:53 AM)
Expanded Robotic Training and Education of Residents and Faculty Surgeons Using Dual Console Robotic Platforms Utilizing Aviation Safety Trans Cockpit Responsibility Gradient Comparisons Breen MT. Ob/Gyn Minimally Invasive and Robotic Surgery, UT Southwestern Ob/Gyn Austin, Austin, Texas Study Objective: The uniqueness of the operating console has created a surgical environment not ever seen in gynecological surgical training. Complexities of learning in the real time operative theater are much more closely modeled by aviation research of cockpit interactions.Objectives of this sudy to contrast and compare single versus dual consoles in a robotic training and learning environment. Design: Survey methodology using a cross sectional survey (Lickert Scale) utilizing Mann Whitney test for result analysis. Survey for both trainers and learners exploring and contrasting ease of instruction,clarity of communication,perception of safety,anxiousness in teaching,anxiousness in learning,perceptions on single console versus dual console,behavioral interaction perceptions. Setting: Dynamic Robotic Training program in a 20 resident Ob Gyn program with 6 robotic trained faculty.High volume of resident and faculty participation on both dual and single console platforms. Patients: Both private patient and staff service patients utilized.These include benign gynecological and gyn oncological cases. Measurements and Main Results: Preference for learning on dual over single console. Preference for training on dual over single console. Perception of safety by learner on dual over single console. Perception of safety by trainer on dual over single console. Acknowledgement of trans console gradient across dual console as compared to single console environment. No perception of more ‘‘near misses’’ with single console over dual console. No perception dual console resulted in better surgical outcomes or superior surgical technique than single console. Conclusion: Dual console training methods have some unique inter personal trainee/trainer dynamics not encountered in traditional open or laparoscopic surgery. Trainees and trainers prefer dual over single console. No perception of better outcomes in dual versus single console.Similiarities between aviation trans cockpit interactions and dual console interactions are percieved.. The role of dual console in robotic training is percieved as beneficial in the training environment. 16
Open Communications 1 - Robotics (11:54 AM - 11:59 AM)
Learning Curve Analysis of Intracorporeal Cuff Suturing during Robotic Single-Site Total Hysterectomy Akdemir A,1 Zeybek B,1 Ozgurel B,2 Oztekin MK,1 Sendag F.1 1Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Bornova, Turkey; 2Department of Actuarial Sciences, Yasar University, Izmir, Bornova, Turkey Study Objective: To analyze the learning curve of intracorporeal cuff suturing during robotic single-site total hysterectomy. Design: Retrospective design.
S6
Abstracts / Journal of Minimally Invasive Gynecology 21 (2014) S1–S44
Setting: University Hospital. Patients: Twenty-four patients with benign indications of hysterectomy. Intervention: Twenty-four patients who underwent robotic single-site total hysterectomy for benign indications were included in the study. Surgical procedures were performed using the single-site platform of the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA). All vaginal cuffs were closed intracorporeally using semi-rigid single-site instruments. Measurements and Main Results: An exponential learning curve technique was used to analyze the two learning curves. The first curve included all of the cases (n=24) and analyzed the entire learning process. In the second analysis, we excluded the initial 4 cases (n=20) because of a change in the type of suture needle after the 4th case, and we only analyzed the learning process of the standard technique. The overall mean vaginal cuff closure time was 23.2 7 minutes. The first learning curve (n=24) plateaued after the 14th case, and the second learning curve (n=20) plateaued after the 10th case.
Table 1 Patient characteristics and surgical outcomes. Median
Range
49.5 28.5 5.5 74.5 25 98.5 22.5 192.5 0 0 0 0
40 - 61 21.7 - 34.2 3-10 60-160 16-41 71-183 7-120 65 - 520
18
Laparoscopic Anterior Exenteration with IntraCorporeal Uretero-Sigmoidostomy Joshi S, Puntambekar SS, Kumar S, Galgali S, Puntambekar SP. Galaxy Care Laparoscopy Institute, Pune, Maharashtra, India In advanced pelvic cancers laparoscopy has been established a one of the modalities for doing anterior exenteration. The problem is not only the advanced procedure, but urinary diversion. There are various diversions available. Continent neo-bladder is not possible in post radiotherapy and post chemotherapy cases in female. the rest of the urinary diversions have an abdominal stoma. In our country stomas are not well accepted. Thus ureterosigmoidostomy is the best option. If this can be done laparoscopically,then the morbidity would be less. In the last 10 years we have done 40 anterior exenterations with uretero-sigmoidostomy. Though hyerchloremic acidosis is a known complication, the biochemical alterations are not so much to require hospitalisation. We present our technique of Laparoscopic anterior exenteration with intra-corporeal ureterosigmoid. 19
Age (yrs) BMI (kg/m2) Docking time (minutes) Console time (minutes) Cuff closure time (minutes) Operating time (minutes) EBL(ml) Uterine weight (gr) Intraoperative complication (n) Postoperative complication (n) Blood transfusion (n) Conversion to laparoscopy/ laparotomy (n) Hospital stay (days)
1
Conclusion: An experienced robotic surgeon required approximately 10 cases to achieve proficiency in intracorporeal cuff suturing during robotic single-site total hysterectomy. Novel instruments that create perfect triangulation are needed to overcome the current challenges of suturing and shorten the operating time.
17
Video Session 1 - Oncology (11:00 AM - 11:06 AM)
Single Port Sentinel Lymph Node Biopsy in Endometrial Cancer Sinno AK, Fader AN, Scheib S, Tanner EJ. The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, Maryland Endometrial cancer (EC) is the most common gynecologic malignancy. Initial therapy includes total hysterectomy plus or minus lymphadenectomy. Sentinel lymph node (SLN) biopsy has been proposed as a way to improve detection rates of EC and minimize morbidity of lymphadenectomy. Single institution data suggest that the SLN can accurately predict overall lymph node status in 92% of cases when used as part of a comprehensive protocol. Single port laparoscopy has been described for use in EC but has not been widely adopted despite possible advantages. Robotic surgery can potentially overcome the counterintuitive and opposite hand-instrument movements that have contributed to a steep learning curve in laparoscopic single site surgery. We present the first case of robotic single site hysterectomy with SLN biopsy and near infrared imaging guidance performed in EC in an effort to demonstrate that lymph node sampling is feasible with this platform.
Video Session 1 - Oncology (11:07 AM - 11:13 AM)
Video Session 1 - Oncology (11:14 AM - 11:20 AM)
Laparoendoscopic Single-Site Radical Trachelectomy Using Conventional Laparoscopic Instruments: A Case Report Chung D,1 Kim SW.2 1Department of Obstetrics and Gynecology, Yonsei University Wonju College of Medicine, Wonju, Kangwon, Republic of Korea; 2Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Republic of Korea Recently, we have experienced a case of laparoendoscopic single-site radical trachelectomy with bilateral pelvic lymph node dissection and para-aortic lymph node dissection using conventional laparoscopic instruments. A 29 year-old unmarried woman who was clinically diagnosed cervical cancer, FIGO stage IB1 was operated under laparoendoscopic single-site approach, using a transumbilical, home-made surgical glove port system. The procedure was performed through a 1.7cm umbilical incision with a single multichannel port system consisting of a wound retractor, a surgical glove, and two 5-mm and one 12mm trocars. The procedure was completed successfully in 371min and estimated blood loss was 320cc. No severe intraoperative and postoperative complication occurred, except 6.7cm sized lymphocele which was found on day 11 and drained. The patient has been followed up for 18 months without any evidence of recurrence. 20
Video Session 1 - Oncology (11:21 AM - 11:27 AM)
Laparoscopic Radical Trachelectomy in a Pregnant Patient with Invasive Cervical Cancer at the Second Trimester Hua K, Yi X. Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China This video is to show the first case of laparoscopic radical trachelectomy in a young pregnant patient with cervical cancer FIGO stage IB1 at the second trimester. During the procedure, pelvic lymph nodes were removed completely and sent for frozen section. The result was reported as negative. Then the excised cervix was removed and sent for frozen section. After a negative endocervical margin was confirmed on frozen section, the cervical stump were closed and the upper vagina sutured. It took us about 6 hours to finish the procedure, no intraoperative complications occurred and blood loss was 400ml. The patient delivered baby at 34.2 week’s gestation. After one more year’s follow-up, both the mother and infant were healthy. Compared to the abdominal and vaginal radical trachelectomy, laparoscopic radical trachelectomy provided a wider and amplified view of surgical fields, and lower disturbance to the mobile of uterus.