Nerve sparing radical hysterectomy: latest developments and historical perspective (original) (raw)
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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...
A nerve-sparing radical hysterectomy: guidelines and feasibility in Western patients
International Journal of Gynecological Cancer, 2002
Surgical damage to the pelvic autonomic nerves during radical hysterectomy is thought to be responsible for considerable morbidity, i.e., impaired bladder function, defecation problems, and sexual dysfunction. Previous anatomical studies and detailed study of surgical techniques in various Japanese oncology centers demonstrated that the anatomy of the pelvic autonomic nerve plexus permits a systematic surgical approach to preserve these nerves during radical hysterectomy without compromising radicality. We introduced elements of the Japanese nerve-preserving techniques and carried out a feasibility study in ten consecutive Dutch patients. The technique involved three steps: first, the identification and preservation of the hypogastric nerve in a loose tissue sheath underneath the ureter and lateral to the sacro-uterine ligaments; second, the inferior hypogastric plexus in the parametrium is lateralized and avoided during parametrial transsection; third, the most distal part of the inferior hypogastric plexus is preserved during the dissection of the posterior part of the vesico-uterine ligament. The clinical study showed that the procedure is feasible and safe, except possibly when used with very obese patients and patients with broad, bulky tumors. Surgical preservation of the pelvic autonomic nerves in radical hysterectomy deserves consideration in the quest to improve both cure and quality of life in cervical cancer patients.
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.
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.
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.
Gynecologic Oncology, 2005
Objectives. This study sought to determine whether intraoperative electrical stimulation (IES) of pelvic splanchnic nerves (PSNs) while monitoring bladder contraction was useful to predict postoperative bladder function during conventional nerve-sparing radical hysterectomy. Methods. Seventeen patients with stage Ib or IIa cervical cancer underwent conventional radical hysterectomy. IES was performed in all cases, stimulating the roots of PSN, the posterior sheath of the vesicouterine ligament (PVL) and the dorsal area of the ligament. After resection of the uterus, the PSN roots were stimulated again. Bladder function was evaluated by urodynamic study (UDS) preoperatively and 3 months after surgery. Results. The results of IES were consistent with bladder function evaluated by postoperative UDS. In 13 of 17 cases, an increased intravesical pressure was observed with IES of the PSN roots after uterus resection. Nine of 13 cases showed marked detrusor contraction with UDS 3 months after surgery and were able to void without using abdominal pressure except in one case. In the remaining 4 of 17 cases, no response could be detected to IES on either side. Three cases voided using abdominal pressure and one used clean intermittent selfcatheterization without spontaneous voiding. Conclusions. IES while monitoring intravesical pressure during radical hysterectomy represents a technically simple and useful procedure for the prediction of postoperative bladder function.
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.
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.