The Application of Tumor-Free Technique in Robotic Single-Site Radical Hysterectomy for Early Stage Cervical Cancer

Abstract Background Cervical cancer ranks as the fourth most common malignancy in women globally. 1 For early stage disease, radical hysterectomy with pelvic lymphadenectomy remains the standard surgical approach. The LACC trial revealed that minimally invasive surgery (MIS) was associated with inferior oncologic outcomes compared with open surgery, 2 with this discrepancy largely attributed to the compromise of tumor-free principles during MIS—particularly through the use of uterine manipulators that may cause mechanical tumor compression and dissemination. 3 While open surgery is generally preferred, MIS may be considered in selected cases, such as tumors ≤ 2 cm according to Chinese guidelines. 4 Patients and Methods To address these concerns, we developed a tumor-free technique incorporating Ma’s suspending band and tumor-shielded vaginal closure, adapted for robotic single-site radical hysterectomy using the da Vinci Xi platform. Results Key features include: (1) ergonomic single-site access through a 3–4 cm umbilical incision accommodating a quad-channel port, enabling simultaneous operation of three robotic arms while preserving a dedicated assistant channel for traction, suction, and irrigation; (2) optimized pneumoperitoneum management through strategic robotic arm positioning that elevates the abdominal wall, ensuring consistent surgical exposure at reduced intra-abdominal pressures (8–10 mmHg versus conventional 12–14 mmHg); (3) minimal parietal trauma through a single-incision approach that improves cosmetic outcomes and potentially reduces port-related complications. Conclusions This video article details the technical execution of our procedure, highlighting its reproducibility and adherence to oncological safety principles. Prospective data collection and follow-up are ongoing to evaluate long-term oncologic outcomes.