Surgical Technique Based on Space Anatomy for Laparoscopic Radical Trachelectomy with Uterine Artery Preservation

Background: To introduce the surgical procedure based on special space anatomy that can safely and efficiently complete the dissociation of the ureter and uterine artery during laparoscopic radical trachelectomy with uterine artery preservation. Methods: We introduce the key technique elements of this surgical procedure using a patient we treated as an example. A 27-year-old patient was diagnosed as well-differentiated cervical adenocarcinoma, stage IB1, and had a strong desire for future fertility. Laparoscopic radical trachelectomy with uterine artery preservation was performed in this patient by using this new surgical technique based on space anatomy. Results: The ureteral space that needs to be dealt with during laparoscopic radical trachelectomy is actually a potential avascular space located medial to the ureter between the anterior leaf (from the axillary space to the fourth space of Yabuki) and posterior leaf (between the paravesical space and paravaginal space) of the vesicouterine ligament. Exposure of the axillary space can help to separate the ureter from the lower uterine segment and uterine artery (uterine side), which is necessary for radical trachelectomy with uterine artery preserved. Multiple "shafts" called potential avascular space can be drilled on the anterior leaf of vesicouterine ligament, and the connective tissue and blood vessels between the "shafts" were cutoff with ultrasonic scalpel. After the paravesical space and paravaginal space were developed, the posterior leaf was isolated and congealed completely by Ligasure. Conclusions: In brief, this new surgical procedure consists of four spaces that can safely and efficiently perform complete excision of the vesicouterine ligament, reduce blood loss, avoid ureteral injury, and shorten the operation time.