Case Report: Fully transvaginal extraperitoneal pelvic lymphadenectomy via retropubic access combined with radical vaginal hysterectomy or trachelectomy for early-stage cervical cancer.

Background: Scarless approaches are increasingly explored in the surgical management of early-stage cervical cancer. Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) has been described for retroperitoneal access and, more recently, for radical hysterectomy and sentinel node biopsy. Here we report a fully transvaginal radical strategy that combines a distinct retropubic extraperitoneal corridor for vaginal endoscopic extraperitoneal lymphadenectomy (VEEL) with radical vaginal hysterectomy or trachelectomy. Case description: Five consecutive women (30-55 years) with FIGO 2018 stage IA2-IB1 cervical cancer underwent retropubic extraperitoneal VEEL followed by radical vaginal hysterectomy or radical vaginal trachelectomy. No abdominal trocar was used. Pelvic lymph node yields were 26, 21, 14, 34 and 10, respectively. At last follow-up (6-64 months), all patients were alive without evidence of disease. The most frequent postoperative morbidity was pelvic lymphocele/collections (2/5), including one symptomatic lymphocele requiring laparoscopic fenestration (Clavien-Dindo IIIb). Conclusion: Retropubic extraperitoneal VEEL combined with radical vaginal surgery may enable oncologically adequate nodal staging without abdominal scars. However, lymphocele/collections observed in this small series underscore the importance of careful patient selection, standardized lymphocele-prevention measures, and consideration of sentinel lymph node mapping to reduce lymphatic morbidity in appropriately staged early disease.