Objective: The publication of a prospective [1] and several retrospective [2,3] studies describing a worse prognosis in patients affected with early-stage cervical cancer who underwent a minimally invasive radical hysterectomy has raised a high concern in what measures should be undertaken in order to revert these results. Potential strategies [4] to prevent tumor spillage have been previously proposed. Methods: In this video, we describe nine strategies that should be addressed in future trials regarding this procedure. Results: These strategies are:1. Fallopian tubes should be coagulated prior to start the surgery.2. All sentinel lymph nodes and lymphadenectomy specimens should be obtained without lymph nodes fragmentation.3. All surgical specimens should be extracted within a containment bag.4. Uterine manipulators must never be used.5. Prior to vaginal section, a closed knotted ligature should be placed around the vagina, proximal to the section line, and the remaining vaginal cavity profusely washed.6. Once the vagina is opened, the surgical specimen should be extracted vaginally within a specimen retrieval bag.7. After surgery, the pelvic cavity is profusely washed with physiological serum, and the vagina should be washed with iodopovidone diluted to 10% [5].8. Port-site metastasis prevention measures should be performed.9. Every action made to prevent tumor spillage should be recorded in the surgical report. Conclusion As there is a biological rationale in these measures that would prevent tumor spillage and seeding, there is a need of prospectively exploring them within appropriate studies in order to determine their own oncological outcome.

Objective: The prognostic impact of surgical paraaortic staging remains unclear in patients with locally advanced cervical cancer (LACC). The objective of our study was to evaluate the results of the surgical technique of preoperative aortic lymphadenectomy in LACC related to tumor burden and disease spread to assess its influence on survival. Methods: Data of 1,072 patients with cervical cancer were taken from 11 Spanish hospitals (Spain-Gynecologic Oncology Group [GOG] working group). Complete aortic lymphadenectomy surgery (CALS) was considered when the lymph nodes (LNs) were excised up to the left renal vein. The extent of the disease was performed evaluating the LNs by calculating the geometric means and quantifying the log odds between positive LNs and negative LNs. The Kaplan-Meier method was used to estimate the survival distribution. A Cox proportional hazards model was used to account for the influence of multiple variables. Results: A total of 394 patients were included. Pathological analysis revealed positive aortic LNs in 119 patients (30%). LODDS cut-off value of −2 was established as a prognostic indicator. CALS and LODDS <−2 were associated with better disease free survival and overall survival than suboptimal aortic lymphadenectomy surgery and LODDS ≥−2. In a multivariate model analysis, CALS is revealed as an independent prognostic factor in LACC. Conclusion When performing preoperative surgical staging in LACC, it is not advisable to take simple samples from the regional nodes. Radical dissection of the aortic and pelvic regions offers a more reliable staging of the LNs and has a favorable influence on survival.