About Prof. Hua Kequn
Prof. Hua Kequn is a leading gynecologic oncologist at the Obstetrics & Gynecology Hospital of Fudan University (Red House Hospital) — one of China's foremost centres for gynecologic oncology and minimally invasive surgery. He specialises in laparoscopic and robotic surgery for cervical, ovarian, and endometrial cancers, and has pioneered the application of single-incision laparoscopic surgery (SILS) to gynecologic malignancies. His clinical philosophy holds that the best cancer surgery cures completely while preserving everything that does not need to be removed — and for a young woman with early-stage cervical cancer, that means preserving ovarian function, protecting sexual quality of life, and leaving no visible scar.
Case Overview
Ms. Chen (pseudonym), a 39-year-old woman, presented with a four-month history of irregular vaginal bleeding. Colposcopy-directed biopsy confirmed invasive squamous cell carcinoma of the cervix; staging established FIGO Stage IB1 disease. She was referred to Prof. Hua Kequn at the Obstetrics & Gynecology Hospital of Fudan University. Ms. Chen's concerns were clear: no visible abdominal scar, minimal pain and recovery time, ovarian preservation, and protection of her sexual quality of life. Prof. Hua's operative plan addressed all of them in a single procedure: transumbilical single-incision 3D laparoscopic radical hysterectomy with pelvic lymph node dissection, bilateral ovarian transposition, and vaginal elongation — complete oncological resection through a 2 cm incision hidden within the umbilicus. Blood loss was 60 mL. She passed flatus on day two, was mobilising on day three, and was discharged without complications. Final pathology confirmed R0 resection with negative margins and negative pelvic lymph nodes. Ms. Chen reflected: "I was terrified — not just of the cancer, but of what the surgery would do to my body. You cannot tell I had surgery at all."
Diagnostic Workup
Colposcopy with directed biopsy confirmed invasive squamous cell carcinoma. Pelvic MRI characterised the primary tumour and confirmed the absence of parametrial invasion. CT of the chest, abdomen, and pelvis identified no lymphadenopathy or distant metastasis. PET-CT excluded occult nodal or distant disease. Cystoscopy and proctoscopy were normal. Multidisciplinary review — gynecologic oncology, radiology, and pathology — confirmed FIGO Stage IB1 disease, the surgical indication for radical hysterectomy with pelvic lymph node dissection, and the oncological safety of ovarian preservation given the squamous histology.
Prof. Hua's pre-operative assessment: Stage IB1 squamous cell carcinoma in a 39-year-old is a disease we can cure surgically with high confidence. Squamous cervical cancer does not metastasise to the ovaries — ovarian preservation is oncologically safe and avoids surgical menopause. The single-incision approach is technically demanding, but it is the right approach for this patient: she will carry the result of this surgery for the rest of her life, and the umbilical scar is the one scar she already has.
Treatment Strategy and Course
Diagnosis: FIGO Stage IB1 Invasive Squamous Cell Carcinoma of the Cervix — surgically resectable, no parametrial involvement, ovarian preservation oncologically appropriate.
Treatment principle: transumbilical single-incision 3D laparoscopic radical hysterectomy with pelvic lymph node dissection, bilateral ovarian transposition, and vaginal elongation — complete oncological resection with no visible scar, preserved ovarian function, and optimised postoperative quality of life.
- Transumbilical single-port access: 2 cm umbilical incision; fascial platform developed; single-port device inserted; 3D laparoscopic visualisation established providing stereoscopic depth perception.
- Instrument configuration: The chopstick effect — instrument collision through a single entry point — was resolved through deliberate length and angle adjustment, strategic sequencing, and articulating instruments.
- Radical hysterectomy (Type C): Complete parametrial resection; uterosacral ligament resection at sacral insertion; 2 cm vaginal cuff; paravesical and pararectal space development; ureter mobilisation; uterine artery ligation at internal iliac origin. Specimen retrieved intact vaginally.
- Pelvic lymph node dissection: Bilateral systematic lymphadenectomy — external iliac, internal iliac, obturator, and common iliac groups; sentinel node identification performed.
- Bilateral ovarian transposition: Ovaries mobilised on vascular pedicles and secured in the paracolic gutters above the planned radiation field, preserving endocrine function if adjuvant radiotherapy is required.
- Vaginal elongation: Vaginal cuff reconstructed and elongated using a peritoneal flap, restoring vaginal length and minimising impact on sexual function.
- Outcomes: Operative time comparable to multiport laparoscopy; blood loss 60 mL; no complications; no conversion. Flatus day two; catheter removed and ambulation day three; discharged without complications.
- Final pathology: Invasive squamous cell carcinoma, moderately differentiated; R0 resection; parametrial and vaginal margins clear; 0/24 pelvic lymph nodes positive; pT1b1N0M0. No adjuvant therapy indicated.
Prof. Hua's clinical reflection: R0 resection, negative nodes, 60 mL blood loss, discharged on day three, no visible scar — this is what the operation is designed to achieve. The single-incision approach does not compromise oncological radicality. What is different is what the patient sees when she looks at her abdomen: nothing. That matters — not as a cosmetic indulgence, but as a statement about what surgery can be when technique is applied in the service of the whole patient.
Expert Commentary — Prof. Hua Kequn
1. Single-Incision Laparoscopy in Gynecologic Oncology
SILS was initially validated for benign gynecological procedures. Extending it to radical cancer surgery is a fundamentally different challenge: complete parametrial resection, systematic lymphadenectomy, and retroperitoneal dissection all demand instrument triangulation and visual clarity that the single-incision platform restricts. The chopstick effect is the central obstacle. Prof. Hua's team addresses it through instrument selection, operative sequencing, and 3D visualisation — achieving the same oncological standards as multiport laparoscopy through a single umbilical incision, with the added benefit of no visible abdominal wound.
2. Ovarian Preservation and Transposition in Young Cervical Cancer Patients
Ovarian preservation is oncologically appropriate in squamous cervical cancer: ovarian metastasis risk is negligibly low, and oophorectomy in a premenopausal woman imposes surgical menopause without benefit. However, if adjuvant pelvic radiotherapy is required, in-situ ovaries will be ablated by the radiation field. Ovarian transposition — securing the ovaries above the radiation field in the paracolic gutters — preserves endocrine function regardless of the adjuvant treatment decision. The procedure adds minimal operative time and is performed through the same umbilical port, requiring no additional incisions.
3. Vaginal Elongation After Radical Hysterectomy
Radical hysterectomy resects 2–3 cm of upper vagina, shortening the vaginal canal — a significant quality-of-life concern in young, sexually active women. Vaginal elongation using a peritoneal flap restores vaginal length at the time of the primary operation, without a second procedure or prosthetic materials. Patient-reported outcomes show improved sexual function scores, reduced dyspareunia, and higher satisfaction. Performing this within the single-incision framework requires precise intracorporeal suturing through the umbilical port — technically demanding, but achievable with 3D visualisation and appropriate instrumentation.
How CMCS Shanghai Coordinated This Case
CMCS Shanghai supported Ms. Chen throughout her pathway at the Obstetrics & Gynecology Hospital of Fudan University, including: priority consultation with Prof. Hua Kequn's team; bilingual interpretation across all oncology, radiology, and surgical planning consultations; bilingual explanation of staging, the operative plan, ovarian transposition, and vaginal elongation; coordination of colposcopy, biopsy, pelvic MRI, CT, PET-CT, cystoscopy, and proctoscopy with bilingual results communication; bilingual surgical consent; postoperative ward coordination and discharge planning; final pathology communication with bilingual staging explanation; and long-term surveillance scheduling.
For international patients and expatriates in China with cervical, ovarian, or endometrial cancer — particularly those seeking minimally invasive approaches that preserve ovarian function and quality of life — Prof. Hua Kequn's team offers access to one of China's most advanced gynecologic oncology programmes. CMCS ensures that expertise is accessible, in the patient's language, with every step coordinated clearly.
This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.
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