484 Laparoscopic nerve sparing radical hysterectomy: Measure to prevent tumor spillage for better prognosis and preservation of voiding function based on clinical pelvic anatomy

Introduction LACC trial suggests intraoperative tumor manipulation and dissemination may compromise survival of early stage cervical cancer with total laparoscopic radical hysterectomy (TLRH). We examined oncological outcome of TLRH with abdominal radical hysterectomy (ARH) and evaluated our surgical technique. Description A case of cervical cancer T1b1 is presented in this video. Patient is 49 years old and endocervix tumor of 1.5 cm is identified in uterine cervix. TLRH is done by Okabayashi method. Technique for good visual field is standardized to reproduce Okabayashi method in every case. TLRH is combined with measures to prevent tumor spillage: 1) avoidance of usage of uterine manipulator, 2) clipping of venous drainage from uterus before manipulating uterine cervix, and clipping central side of lymph drainage before pelvic lymph node dissection, 3) irrigate vagina and close vaginal cuff before colpotomy. Cox proportional hazard model confirmed that oncologic outcomes were similar between 2 groups (29 cases in TLRH group and 35 cases in ARH group), including disease free survival (DFS, HR: 0.2441, 95%CI: 0.02852–2.09, p=0.198) and overall survival (OS, HR: 1.676, 0.1045–26.85, p=0.7152). Local recurrence was observed in 4 cases of ARH group (11%) but none in TLRH group. Metastasis was observed in 1 case of ARH group and 1 case of TLRH group. Conclusion/Implications TLRH done by Okabayashi method is accepted when combined with preventive method of tumor spillage. Tumor should be isolated, and irrigation of vagina and vaginal cuff closure before colpotomy is needed in both groups.