A nerve-sparing radical hysterectomy: guidelines and feasibility in Western patients (original) (raw)
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International Journal of Gynecological Cancer, 2006
The objectives were to describe our nerve-sparing class III radical hysterectomy technique and assess the feasibility and safety of the procedure as well as its impact on voiding function. From January to August 2005, 21 consecutive patients with FIGO stage IB-IIA cervical cancer and 1 patient with clinical stage II endometrial cancer underwent nerve-sparing radical hysterectomy with systematic pelvic lymphadenectomy. The transurethral catheter was removed on the seventh postoperative day. Then intermittent self-catheterization was performed and post-void residual urine volume (PVR) was recorded. The nerve-sparing procedure was completed successfully and safely in all of the patients. Eight (36%) and 6 (27%) patients had the PVR of < 100 ml and < 50 ml respectively at the initial removal of the catheter. On the fourteenth day, 82% and 77% of the patients had the PVR of < 100 ml and < 50 ml, respectively. The mean duration before the PVR became < 50 ml was 11.27 (5-26) days. In conclusion, the technique described in this preliminary study appears safe, adequate, and feasible in our population with satisfactory recovery of voiding function. A larger comparative study is needed on long-term urinary, bowel, and sexual function as well as recurrence and survival.
Surgical and Radiologic Anatomy, 2003
pre´servation nerveuse doit eˆtre mise en balance avec les priorite´s carcinologiques d'exe´re`se du cancer et de toutes ses voies potentielles de disse´mination locale. A. Ercoli AE V. Delmas AE P. Gadonneix AE F. Fanfani R. Villet AE P. Paparella AE S. Mancuso AE G. Scambia Electronic Supplementary Material The french version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer Link server located at http:// dx.
The Tohoku Journal of Experimental Medicine, 2007
Radical hysterectomy has been performed for invasive cervical cancer, and autonomic nerve-sparing procedures have been developed to preserve bladder function. To perform and improve the nerve-sparing radical hysterectomy, it is important to understand anatomy of the intra pelvic fasciae, specially vesico-uterine ligament (VUL), because most of injuries to the nerves occurred during incision of the VUL in radical hysterectomy procedures. The objectives of the present study were to provide histological understanding of major structures found in nervesparing radical hysterectomy. Serial macroscopic slices (15-20 mm thick) from five female pelves were trimmed and prepared for paraffin-embedded histology. We noted an anatomical entity as "the visceroparietal fascial bridge", which corresponds with the macroscopically identified arcus tendineus fasciae pelvis. A histologically identifiable neurovascular pedicle to the bladder neck corresponded with the deep portion of VUL. These findings could help better preservation of autonomic nerves during radical hysterectomy and improve patient's quality of life after the operation. Translation of surgical anatomy into anatomic terminology enables us to have fruitful discussions with persuasive power by excluding any bias from individual surgeons. vesico-uterine ligament; paracolpium; parietal fascia; levator ani; radial hysterectomy; autonomic nerve
Annals of surgical oncology, 2014
Success factors of laparoscopic nerve-sparing radical hysterectomy (LNRH) to preserve bladder function are little known despite its widespread use. Thus, we conducted a protocol-based prospective cohort study to evaluate clinicopathologic factors for preserving autonomic nerves and its impact on duration of postoperative catheterization (DPC). From 2012 to 2014, 30 patients with stage IB1 to IIA2 cervical cancer were recruited prospectively to undergo LNRH. All procedures were performed on the left side of the patients by one gynecologic oncologist. Extent of resection and preservation of autonomic nerves were documented in the protocol during LNRH. All patients received laparoscopic type C1 radical hysterectomy, where extent of resection and preservation of autonomic nerves were not different between the right and left sides. Stage IB1 disease was associated with the reduced risk of injury of the left junctions between the hypogastric and the splanchnic nerves; between the splanchn...
Preservation of Autonomic Nerves in Laparoscopic Total Radical Hysterectomy
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2010
Objectives: The aim of this study was to evaluate the feasibility, complications, margin status, and functional outcome (on urinary and sexual functions) of nerve-sparing radical hysterectomy (NSRH) performed laparoscopically. Methods: Patients with cervical carcinoma of stage Ia2 and Ib1 underwent laparoscopic NSRH along with pelvic lymphadenectomy. We performed the technique in simple comprehensible steps with anatomic delineation of the autonomic nerves and selective cutting of the uterine and cervical branches. Results: Laparoscopic NSRH was feasible in 85.7% of patients. Mean operative time was 160 minutes and all 7 patients had clear surgical margins. There were no complications and no blood transfusions were required. The median hospital stay was 3 days. The median return time for normal bladder function was 2 days and none of them required catheterization beyond 2 weeks. The mean residual urine volume was <50 mL. Urodynamic studies performed at 3 weeks after the operation showed no impairment of maximum flow rate (maximal flow rate: 20 AE 2 mL). The postoperative results of sexual dysfunction were inconclusive. Conclusion: Understanding this technique and the knowledge of laparoscopic anatomy of pelvic autonomic nerves is important in both benign and malignant pelvic surgeries. These preliminary results indicate that nerve sparing is easier done laparoscopically and its results are comparable to that of conventional laparoscopic radical hysterectomy in terms of lateral margin status and lymph node yield. Whether quality of life can be benefited by L-NRSH technique and its long-term oncological sequelae need further evaluation.
Nerve Sparing in Radical Surgery for Early-Stage Cervical Cancer
International Journal of Gynecological Cancer, 2010
Radical hysterectomy with pelvic lymphadenectomy is considered to be the cornerstone in the treatment of early-stage cervical cancer. Although survival in early-stage cervical cancer is up to 95%, long-term morbidity with regard to bladder, bowel, and sexual function is considerable. Damage to the pelvic autonomic nerves may be the cause of these long-term complications following radical hysterectomy. Some authors have presented surgical techniques to preserve the autonomic nerves (ie, the hypogastric nerves and the splanchnic nerves) without compromising radicality. Safety, efficacy, and the surgical techniques of nerve-sparing radical hysterectomy are presented, and data confirm that whenever the decision is made to perform a radical hysterectomy, nerve-sparing techniques should be considered.
A prospective study of nerve-sparing radical hysterectomy for uterine cervical carcinoma in Taiwan
Taiwanese Journal of Obstetrics & Gynecology, 2012
Objective: Surgical therapy for cervical carcinoma carries a significant risk of functional impairment to the bladder. This study evaluates the feasibility and complications of nerve-sparing radical hysterectomy (NRH) in Taiwan. Methods: Between March 2010 and March 2011, consecutive patients diagnosed with early stage cervical cancer (FIGO stage Ia2 to Ib1) and tumor size < 3 cm were recruited prospectively to undergo NRH or conventional radical hysterectomy (RH). Patients with histories of urinary stress incontinence or bladder dysfunction disease were excluded. A modified Tokyo nerve-sparing radical hysterectomy was performed. Results: A total of 30 patients were enrolled. Among these, 18 patients underwent NRH with successful bilaterally nerve-sparing procedures in 15 cases (83%), unilaterally nerve-sparing procedures in 2 cases (11%), and a failure in 1 case (6%). The indwelling catheter was removed on postoperative day 6. The mean AE SD duration from operation to spontaneous voiding was 6.8 AE 1.5 days for women who underwent NRH; the corresponding duration for women who underwent RH or failed NRH was 20.6 AE 3 days. None of the patients who underwent NRH required intermittent catheterization. All 12 patients who underwent RH needed self-catheterization after discharge. There was a significant reduction in the incidence of postoperative self-catheterization (p < 0.01) and bladder dysfunction (p < 0.006). Average satisfaction score analyzed by the Likert-scale questionnaire was 4.5 for the NRH group and 1.9 for RH group (p < 0.0001). Conclusions: We concluded that the new technique of NRH can reduce postoperative bladder dysfunctions.
Feasibility and Functional Outcome of Laparoscopic Nerve Sparing Radical Hysterectomy
Zagazig university medical journal, 2018
Aim: Evaluation of the feasibility of laparoscopic nerve sparing radical hysterectomy in comparison to the nonnerve sparing type. Methodology:Patient recruitment started from November 2014 to November 2016, patients who underwent laparoscopic type C1 hysterectomy and laparoscopic type C2 hysterectomy according to Querleu-Morrow classification(1) at our departments were prospectively evaluated. The inclusion criteria included: Patients with cervical carcinoma Stage IA2 to stage IIB cervical cancer according to FIGO staging and Stage II-III endometrial cancer with cervical involvement according to FIGO staging. Postoperative drainage of the bladder through a Foley catheter was maintained for 2 days and removed on the third day and the patients were asked to perform spontaneous voiding every 3 hours followed immediately by drainage of the bladder by urinary catheter to assess the post void residual (PVR) urine volume. The procedure was repeated until the PVR is less than 100 ml. The voiding function was considered normal when the patient had 2 consecutive measurements of PVR urine less than 100 ml and abnormal if the patient had a PVR urine more than 100 ml with need of self-catheterization after 4 weeks from the date of surgery. Results:46 patients were included in the study, 30 patients underwent type C1 LNSRH (Group A) and 16 patients underwent type C2 LRH (Group B). The mean age was 49.1±13.1 and 51.2±11.8, median BMI was 26.2(22.9-28.5) and 23.8(21-26.6) respectively for the 2 groups. The mean operative time was 240.1±65.5 in group A and 308.1±83 in group B (P value=0.004). The rate of intraoperative complications was 10% in group A and 12.5% in group B. The median duration of postoperative catheterization until the PVR urine volume was less than 100 ml was 3.5(3-5) days in group A and 6(4-8.5) days in group B (P value=0.002), The rate of late postoperative complications including bladder dysfunction was 3.3% (Group A) and 31.25% (Group B) (P value 0.002). Conclusion:Our study results supported the feasibility of LNSRH technique with better functional outcome without compromising the oncologic safety of the procedure