Robotic-Assisted Laparoscopic Trachelectomy and Sacrocolpopexy Revision for Endometrial Intraepithelial Neoplasia

INTRODUCTION: Pelvic organ prolapse is a loss of support to the pelvic organs and can present as symptoms of a vaginal bulge, urinary dysfunction, or defecatory dysfunction. Symptomatic prolapse affects approximately 3–6% of the general population. Sacrocolpopexy, which suspends the vagina to the anterior longitudinal ligament with the aid of a synthetic permanent mesh, is the most durable reconstructive surgery for prolapse. Sacrocolpopexy is often combined with a total or supracervical hysterectomy, although it can be performed as a uterine-sparing sacrohysteropexy. OBJECTIVE: To present a case of robotic-assisted laparoscopic trachelectomy and sacrocolpopexy revision for endometrial intraepithelial neoplasia (EIN). METHODS: N/A. RESULTS: A healthy 63-year-old female with stage 3 pelvic organ prolapse underwent an uncomplicated laparoscopic supracervical hysterectomy, bilateral salpingectomy, sacrocervicopexy, perineorrhaphy, and cystoscopy. On postoperative day 7, the surgical pathology returned with diffuse EIN. Gynecologic oncology was consulted and offered the options of expectant management, which would result in substandard treatment, or cervical excision, which was felt to complex given the patient’s recent sacrocervicopexy. The patient desired cervical excision, and on postoperative day 9, she returned to the operating room for a robotic-assisted laparoscopic trachelectomy and revision sacrocolpopexy. Please refer to attached surgical video. The patient’s postoperative course was uneventful; she has not had prolapse recurrence or mesh exposure at 6 months postoperatively. CONCLUSIONS: We present this video to document a case of trachelectomy after sacrocolpopexy and show that in the event of EIN following supracervical hysterectomy with sacrocervicopexy, expeditious revision and meticulous tissue handling are essential for safe and successful completion of surgery without compromising the prolapse repair.