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

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.