Video 1 Surgery starts with a biopsy of any suspicious area for metastasis. Right round ligament section. Right paravesical space dissection. Opening of the two leaves of the broad ligament and dissection of the right infundibulopelvic ligament. Previous pelvic lymphadenectomy makes it more difficult to dissect the infundibulopelvic ligament. Care must be taken to avoid damaging the ovarian vessels. Suture granulomas. The ovary is detached from the ovarian fossa at this point. Care is taken to

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... void grasping the tubes or the infundibulopelvic ligaments in order to avoid damaging them or damaging the vascular supply of the uterus, all of which could harm future fertility. The right gonadal vessels are dissected as cranially as possible. The same steps are repeated on the left side. The uterus is moved posteriorly by manipulation and the vesicouterine septum is dissected. The uterine vessels are coagulated and cut. For stage IA1 tumors, the paracervix is transected just lateral to the cervix as in an extrafacial hysterectomy. Some of the vagina is debrided from the cervix. The vagina is then closed using two layers of absorbable suture. It is important to keep in mind the risk of vaginal cuff dehiscence due to radiation. Double docking is used and the patient is kept in the Trendelenburg position. The invention of the docking allows correct upper abdominal dissection. Lateral to medial dissection of the terminal ileum, cecum, and right colon. The right gonadal vessels are gently dissected cranially, up to the level where the uterine artery crosses the vena cava. The same steps are repeated on the left side. The uterus is mobilized to the upper abdomen. Care must be taken to avoid twisting of the infundibulopelvic ligaments. The cecum, ileum, and omentum are gently moved beneath the arch formed by the infundibulopelvic ligaments. The same is done with the left colon. As the residual cervix was too short to be attached to the umbilical scar, we decided to keep it inside the abdominal cavity. Then 2-0 polypropylene sutures were performed to attach the uterus to the anterior abdominal wall. The round ligaments were fibrotic and short so we did not use them to attach the uterus to the abdominal wall. Using routine laparoscopy, the uterus was detached from the anterior abdominal wall and all adhesions were released. The docking was performed and the uterus positioned back to the pelvis. Dissection of the pelvic adhesions is important to restore anatomy. A vaginal probe is inserted and the vaginal vault is dissected. Care should be taken due to the presence of the bladder vault. The cervix is then debrided removing any fibrotic tissue. The uterus is sutured to the vagina to keep it in place for the placement of a polypropylene cerclage. This suture cannot be too tight to avoid cervical stenosis. The suture of the residual cervix to the vagina is then completed using absorbable sutures. The round ligaments and broad ligaments are reconstructed using polypropylene 3-0 sutures to avoid inflammatory reaction and adhesions. Care must be taken at this point to avoid puncture of the iliac vessels or the gonadal vessels. The broad ligaments are reconstructed on the right side. This is the end of the procedure.