Pneumovaginoscopy-assisted radical hysterectomy for early-stage cervical cancer - a novel bidirectional approach for tumor spillage prevention and R0 resection

Sep 28, 2026

Uploaded by Aran

This retrospective observational cohort study evaluates pneumovaginoscopy-assisted radical hysterectomy (PVRH) for cervical cancer up to stage IIA using a bidirectional fascia-oriented and nerve-sparing surgical approach. Patients underwent Kyoto B2 radical hysterectomy with pelvic lymphadenectomy via simultaneous vaginal and abdominal routes (open or laparoscopic), while pneumovaginoscopy created a vaginal cuff and supported paracolpium/paracervical fascia dissection to minimize nerve injury. Among 59 patients, microscopic R0 was achieved in all, median follow-up was 44.5 months, and no recurrence occurred.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages14

Reading Time35 min

AccessFree to download

Abstract

Synopsis

Introduction

J Gynecol Oncol. 2023 Nov;34(6):e80 [https://doi.org/10.3802/jgo.2023.34.e80](https://doi.org/10.3802/jgo.2023.34.e80)[ ](https://doi.org/10.3802/jgo.2023.34.e80)pISSN 2005-0380·eISSN 2005-0399 Original Article Received: Jan 30, 2023 Revised: Jun 15, 2023 Accepted: Jun 24, 2023 Published online: Jul 6, 2023 Correspondence to Masato Kita Department of Obstetrics and Gynecology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan. Email: [kitamas@hirakata.kmu.ac.jp](kitamas@hirakata.kmu.ac.jp) © 2023. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology, and Japan Society of Gynecologic Oncology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ([https://](https://)[ ](https://)[creativecommons.org/licenses/by-nc/4.0/](creativecommons.org/licenses/by-nc/4.0/)) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ORCID iDs Masato Kita [https://orcid.org/0000-0002-0986-5495](https://orcid.org/0000-0002-0986-5495)[ ](https://orcid.org/0000-0002-0986-5495)Yusuke Butsuhara [https://orcid.org/0000-0002-4948-9869](https://orcid.org/0000-0002-4948-9869)[ ](https://orcid.org/0000-0002-4948-9869)Yoji Hisamatsu [https://orcid.org/0000-0002-8872-4972](https://orcid.org/0000-0002-8872-4972)[ ](https://orcid.org/0000-0002-8872-4972)Takuya Yokoe [https://orcid.org/0000-0001-8506-0464](https://orcid.org/0000-0001-8506-0464)[ ](https://orcid.org/0000-0001-8506-0464)Hidetaka Okada [https://orcid.org/0000-0002-7932-6999](https://orcid.org/0000-0002-7932-6999) Pneumovaginoscopy-assisted radical hysterectomy for early-stage cervical cancer: a novel bidirectional approach for tumor spillage prevention and R0 resection Masato Kita , Yusuke Butsuhara , Yoji Hisamatsu , Takuya Yokoe , Hidetaka Okada Department of Obstetrics and Gynecology, Kansai Medical University, Hirakata, Japan ABSTRACT Objective: This study evaluated the feasibility and outcomes of pneumovaginoscopy-assisted radical hysterectomy (PVRH) for cervical cancer up to stage IIA using a bidirectional fasciaoriented and nerve-sparing surgical approach. Methods: This retrospective observational cohort study examined the operative outcomesand prognoses of patients who underwent PVRH (n=59) for up to stage IIA cervical cancer. The basic procedure was Kyoto B2 (Viper Type II nerve-sparing) radical hysterectomy and pelvic lymphadenectomy through simultaneous vaginal and abdominal (open or laparoscopic) approaches. In all cases, pneumovaginoscopy (PV) was used to create a vaginal cuff and dissect the paracolpium and paracervical endopelvic fascia to minimize nerve damage. Results: Thirty-eight (64.4%) patients had stage IB1 cancer. Seven (11.9%) had vaginal invasion (stage IIA1, n=4; IIA2, n=3) . The abdominal approach was open in 38 cases and laparoscopic in 21. Adjuvant therapy was administered to 24 patients (41%); one patient received concurrent chemoradiotherapy for gastric-type adenocarcinoma. There were three (6.1%) intraoperative complications (CO2 gas embolism [n=1], sigmoid colon musculosa injury [n=1], and ureteral injury [n=1]) and 8 (14%) postoperative complications (lymphedema with cellulitis [n=4], vaginal cuff dehiscence [n=1], sub-ileus [n=1], symptomatic lymphocyst [n=l], and ureterovaginal fistula [n=1]) . The median urination recovery period was 3 days. Microscopic R0 was achieved in all cases. The median follow-up was 44.5 (2–122) months, and no recurrence occurred. Conclusion: PVRH is a new fascia-oriented and nerve-sparing surgery for early-stage cervical cancer. Further, it has favorable operative outcomes and good prognoses, similar to those of adjacent pelvic surgery such as trans-anal total mesorectal excision and radical prostatectomy. Keywords: Cervical Cancer; Hysterectomy; Natural Orifice Transluminal Endoscopic Surge

FAQs

What is pneumovaginoscopy-assisted radical hysterectomy (PVRH) in this study?

PVRH is a bidirectional (vaginal and abdominal) fascia-oriented and nerve-sparing radical hysterectomy technique. Pneumovaginoscopy is used to create a vaginal cuff and to help dissect relevant pelvic fascia to reduce nerve damage.

How was the operation performed and what surgical approach was used?

Patients received Kyoto B2 radical hysterectomy and pelvic lymphadenectomy through simultaneous vaginal and abdominal approaches (open or laparoscopic). Pneumovaginoscopy supported dissection around the paracolpium and paracervical endopelvic fascia.

What outcomes were reported regarding margin status and recurrence?

Microscopic R0 was achieved in all cases. During a median follow-up of 44.5 months, no recurrence was observed.

Sep 28, 2026

Uploaded by Aran