Minimally invasive surgery for early-stage cervical cancer: Rediscovering the Schautheim robot-assisted procedure - 17/01/21

Doi : 10.1016/j.jogoh.2020.101980

Hélène Courcier ^a, Henri Azaïs ^a,^⁎ , Jérémie Belghiti ^a, Catherine Uzan ^a,^b,^c, Geoffroy Canlorbe ^a,^b,^c
^a AP-HP (Assistance Publique des Hôpitaux de Paris), Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière University Hospital, Paris, France
^b NSERM UMR_S_938, "Cancer Biology and Therapeutics", Centre de Recherche Saint-Antoine (CRSA), Sorbonne University, France
^c Institut Universitaire de Cancérologie (IUC), Sorbonne University, Paris, France

^⁎Corresponding author at: Department of gynecologic and breast surgery and oncology, University Hospital Pitié-Salpêtrière, 45-83 boulevard de l’Hôpital, 75013 Paris, Sorbonne University, France.Department of gynecologic and breast surgery and oncologyUniversity Hospital Pitié-SalpêtrièreSorbonne University45-83 boulevard de l’HôpitalParis75013France

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Abstract

Introduction

The Laparoscopic Approach to Cervical Cancer (LACC) trial recently showed a significant inferiority of the minimally invasive surgery when we considered them both equivalent in the treatment of cervical cancer. The objective of this article is to describe and discuss the interest of the Schautheim procedure.

Surgical technique

The Schautheim is the association of a radical hysterectomy by laparoscopy/robot assisted or not as described by Wertheim after a primary vaginal closure, like the first step of Schauta’s hysterectomy. This technique is described in ten steps, with a video material.

Discussion

The return to open surgery could lead to a loss of benefits associated with the laparoscopic approach in terms of per and post-operative morbidity. One way to achieve similar results would be to prohibit the use of uterine manipulators and create a vaginal cuff.

Conclusion

Several authors suggest that early-stage cervical cancer patients could still be operated by laparoscopy without reducing overall survival or increasing risk of recurrence if certain measures are followed.

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Keywords : Early-stage cervical cancer, LACC trial, Minimally invasive surgery, Schautheim procedure