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Objective: To report the surgical, oncological, and obstetrical outcomes of the different surgical techniques used for the fertility-sparing treatment of patients with early-stage cervical cancer. Methods: We retrospectively analyzed all fertility-sparing procedures performed between 2004 and 2020. The study included patients desiring to preserve fertility who had squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma histology, all grades, and FIGO 2009 stage IA2-IB1 tumors. Results: 48 patients met the inclusion criteria. Eight patients (16.7%) had stage IA2, and 40 (83.3%) had stage IB1 tumors. Conization with pelvic lymph node assessment was performed in 5 (10.4%) patients, an open radical trachelectomy in 21 (43.8%), and a laparoscopic radical trachelectomy in 22 (45.8%). No major intraoperative complications were registered. Two patients required surgery due to an early postoperative complication. Late postoperative complications were seen in 15 patients (31.2%), with cervical stenosis being the most frequent (60%). The rate of DFS at 2 and 5 years was 89% (95% CI, 76-95%), and the 5- year OS was 96% (95% CI, 83-98%). Univariate analysis demonstrated a relationship between tumor size and recurrence, but not for other prognostic tumor factors or surgical approach. One patient (4.8%) developed recurrent disease in the open radical trachelectomy group, and five (22.7%) in the laparoscopic radical trachelectomy group. The pregnancy rate was 41.4%, and the live birth rate 88.2%. Conclusion: Fertility-sparing treatment for patients with early-stage cervical cancer is ever-evolving. This study adds information to the literature about the outcomes of these quite uncommon procedures, and allows a critical analysis of many of the topics which are under discussion.
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INTRODUCTION AND HYPOTHESIS: Leiomyomas of the urinary bladder are rare tumors. Submucosal leiomyomas, when small and easily accessible, can be treated with transurethral resection, while unfavorably positioned or larger leiomyomas may be treated through an abdominal approach. In these cases, a laparoscopic approach for intravesical surgery is an alternative that may be considered. We aim to demonstrate a novel transvesical laparoscopic approach to bladder leiomyoma excision with a video. METHODS: A 45-year-old woman with urinary symptoms and a 40-mm submucosal bladder leiomyoma located at the interureteric ridge was referred to our hospital (tertiary referral hospital). Due to the location and size of the leiomyoma, and to increase the probability of complete resection, a transvesical laparoscopic approach was decided. A step-by-step video is presented to describe the surgical technique. RESULTS: There were no intra- or postoperative complications. The patient was discharged 48 h after the surgery. At 60 months' follow-up, the patient remains asymptomatic. CONCLUSIONS: Transvesical laparoscopy may be considered for excision of bladder leiomyomas. This approach is feasible for trained surgeons as it requires a small working space.