Vaginally Assisted Laparoscopic Radical Hysterectomy in Mexico.

We report the first three cases of vaginally assisted laparoscopic radical hysterectomy in Mexico. Two patients with cervical cancer stage 1B and one patient stage 1A2 (FIGO) were selected. The procedure starts with a careful evaluation of the abdominal cavity. The round ligament is cut with monopolar energy and both leaves of the broad ligament are opened. The infundibulopelvic ligament is sutured and cut. Then we proceed with the pelvic lymphadenectomy, which includes: dissection of the common iliac vessels, hypogastric and external iliac vessels, and the obturator nerve to the pelvic floor. Then we developed the pararectal space by suturing the uterine artery in one case vaginally and in two cases laparoscopically. Then we continued vaginally and 3 cm of vagina were removed. The average number of pelvic nodes obtained was 22 (15-31 nodes). The women were discharged on the seventh postoperative day without complications. The follow-up is from 2 weeks to 6 months and all of them are alive without tumor activity. This is a procedure that can be done as an alternative to laparotomy for cervical cancer with all the advantages of laparoscopy.