Mini-laparotomic-assisted laparoscopic radical hysterectomy: an innovative technique for cervical cancer surgery—a case series

Purpose: To assess the feasibility, safety, and short-term surgical outcomes of mini-laparotomic-assisted laparoscopic radical hysterectomy in the treatment of early-stage cervical cancer. This pilot feasibility case series is the first to provide a detailed description of the technique and its initial clinical results. Methods: A retrospective case series of seven women with early-stage cervical cancer underwent mini-laparotomic-assisted laparoscopic radical hysterectomy at a single tertiary care center between November 2023 and October 2024. The surgical procedure included laparoscopic pelvic lymphadenectomy, radical hysterectomy, and salpingectomy, followed by colpotomy and uterine extraction through a mini-laparotomy (4–8 cm). Data on baseline characteristics, intraoperative parameters, and postoperative outcomes were collected and analyzed retrospectively. Results: The median age was 50 years (range 42–76), and the median BMI was 27.9 kg/m² (range 20–43). Histological subtypes included five cases of squamous cell carcinoma, one case of adenocarcinoma, and one case of adenosquamous carcinoma. Pathological staging revealed IB2 in three patients, IA1 in two, and one each for IB1 and IA2. The median operative time was 345 min (range 295–395), and the median estimated blood loss was 500 mL (range 200–700). No intraoperative or postoperative complications were reported. Conclusion: Mini-laparotomic-assisted laparoscopic radical hysterectomy appears to be a feasible and safe surgical option for early-stage cervical cancer. This technique combines the oncologic rigor of open surgery with the advantages of minimally invasive methods, addressing significant limitations of conventional laparoscopy, including tumor manipulation and intracorporeal colpotomy performed under CO₂ pneumoperitoneum. As the initial report describing this approach, the findings support its potential as an effective alternative to the traditional open radical hysterectomy. Further studies involving larger cohorts and long-term follow-up are needed to validate its oncologic and perioperative benefits.