Rescue radical trachelectomy for preservation of fertility in benign disease

Objectives To report a series of patients treated with modified radical abdominal trachelectomy to preserve fertility in benign disease that would normally result in hysterectomy. Design We reviewed all cases of radical abdominal trachelectomy performed for nonneoplastic indications. Patient(s) Of the >160 radical abdominal trachelectomies we performed, four cases were performed for benign indications. One patient had a 10-year history of progressive endometriosis with worsening hydronephrosis, failed medical therapy, and infertility. Two myomectomy patients had intraoperative consultation and a third had preoperative consultation for large lower segment/cervical myomas with conversion to trachelectomy rather than hysterectomy. Intervention(s) Modified radical trachelectomy was successfully completed in all patients. Main Outcome Measure(s) We measured the successful completion of the surgery without hysterectomy, complications, and follow-up. Result(s) Hysterectomy was avoided in all patients, and all resumed normal menses. There were no intraoperative or postoperative complications. One required hysterectomy for recurrence 1 year later, and the remainder were symptom free at 1–5 years of follow-up. Conclusion(s) Although traditionally performed with cervical cancer, radical abdominal trachelectomy can be modified to preserve fertility for benign indications that would otherwise require hysterectomy.