Abstract
Radical hysterectomy is a standard operation for patients with early-stage cervical
cancer. Over the recent decades, laparoscopic radical hysterectomy has been considered
an alternative treatment. In 2018, the results of the laparoscopic approach to cervical
cancer trial suggested that women with early-stage cervical cancer who underwent minimally
invasive surgery for radical hysterectomy had poorer prognosis than those who underwent
open surgery. This finding was unexpected, and direct evidence supporting poor prognosis
related to minimally invasive radical hysterectomy was not available because the trial
was not designed to evaluate the cause of the inferior outcomes. Tumor spillage caused
by surgeon-related factors, including squeezing of the uterine cervix and tumor exposure
to circulating CO2 gas, is considered to be associated with the poor prognosis of patients who underwent
minimally invasive radical hysterectomy. We believe that protective maneuver to avoid
tumor spillage is the key to improve oncologic outcomes of cervical cancer. Here,
we present a procedure of total laparoscopic nerve-sparing radical hysterectomy for
early-stage cervical cancer in which techniques, such as the “no-look no-touch technique,”
were used to prevent tumor spillage.
Keywords
cervical cancer - laparoscopic radical hysterectomy - nerve-sparing - no-look no-touch
technique - tumor spillage
