Case Report :Management of Pregnancy and Delivery After Total Laparoscopic Radical Trachelectomy
Background: The recent increase of cervical carcinoma in younger women has led us to introduce a total laparoscopic radical trachelectomy (TLRT) Our procedure has wider parametrial resection than the vaginal radical trachelectomy (VRT). We applied our TLRT to patients with both adenocarcinoma and squamous cell carcinoma with a diameter less than 20mm and could obtain a 15mm surgical margin.
Cases: Between 2002 and 2008 we performed 38 cases of TLRT. Nine patients became pregnant. Two cases resulted in miscarriage. Two cases were missed abortions. Two cases are currently 23 weeks and 26 weeks. Three cases reached the 3rd-trimester and delivered. Two patients had PROM at 26 and 34 weeks. One had a poor biological profiling score at 36 weeks. All underwent emergency cesarean sections. Unexpectedly, we didn't experience any trouble during the cesarian sections of patients at 34 and 36 weeks but observed the enlargement of the lower uterus despite having removed the isthmus.
Conclusion: RT has long been accepted as the standard fertility-sparing procedure. Although we had concerns about the uterus function disorder because of the wider resectioning of the parametrium in our procedure, 3 patients became pregnant and have infants. Our TLRT meets the fertility-sparing parameters while extending the radicality, making it an effective treatment for patients who require more extensive resection.