LAUSR

Radical trachelectomy can be performed via vaginal, open abdominal, or laparoscopic approaches. Each approach to radical trachelectomy has its own strengths and weaknesses. Previous publications have shown the technical feasibility and advantages of laparoscopic radical trachelectomy in reduced blood loss and shorter hospital stay, which has become the dominant modality for trachelectomy since 2011. However, two highprofile publications have left many reconsidering their surgical approach to the management of earlystage cervical cancer. 4 We introduce an innovation, the vaginalassisted gasless laparoendoscopic singlesite (LESS) radical trachelectomy, which combines the strengths of different approaches for early cervical cancer. Video 1 shows this surgical procedure in a 34yearold woman (gravida 1 para 0) with stage IB1 cervical adenocarcinoma desiring future fertility. Vaginalassisted LESS radical trachelectomy with abdominal suspension was performed. First, systematic bilateral pelvic lymphadenectomy was performed and lymph nodes were negative on frozen section. The tumoradapted vaginal cuff was created and vesicovaginal and rectovaginal spaces were opened. Gasless LESS (Online Supplemental File 1) radical trachelectomy was performed using an extrauterine manipulator; both of the uterine arteries were spared. The radical trachelectomy specimen was then cut off using an electric knife distal to the bifurcation of the ascending and descending uterine arteries. Frozen