Nerve-sparing radical hysterectomy: steps to standardize surgical technique

2019 ◽  
Vol 29 (7) ◽  
pp. 1203-1208 ◽  
Author(s):  
Mustafa Zelal Muallem ◽  
Yasser Diab ◽  
Jalid Sehouli ◽  
Shingo Fujii
Keyword(s):  
Radical Hysterectomy ◽  
Splanchnic Nerve ◽  
Primary Objective ◽  
Autonomic Nerve ◽  
Surgical Approaches ◽  
Nerve Sparing ◽  
Inferior Hypogastric Plexus ◽  
Splanchnic Nerves ◽  
Hypogastric Plexus ◽  
Pelvic Splanchnic Nerves

AimThe primary objective of this review was to study and analyze techniques of nerve-sparing radical hysterectomy so as to be able to characterize and elucidate intricate steps for the dissection of each component of the pelvic autonomic nerve plexuses during nerve-sparing radical hysterectomy.MethodsThis review was based on a five-step study design that included searching for relevant publications, selecting publications by applying inclusion and exclusion criteria, quality assessment of the identified studies, data extraction, and data synthesis.ResultsThere are numerous differences in the published literature concerning nerve-sparing radical hysterectomy including variations in techniques and surgical approaches. Techniques that claim to be nerve-sparing by staying above the dissection level of the hypogastric nerves do not highlight the pelvic splanchnic nerve, do not take into account the intra-operative patient position, nor the fact that the bladder branches leave the inferior hypogastric plexus in a ventrocranial direction, and the fact that inferior hypogastric plexus will be drawn cranially with the vaginal walls (if this is not recognized and isolated earlier) above the level of hypogastric nerves by drawing the uterus cranially during the operation.ConclusionsThe optimal nerve-sparing radical hysterectomy technique has to be radical (type C1) and must describe surgical steps to highlight all three components of the pelvic autonomic nervous system (hypogastric nerves, pelvic splanchnic nerves, and the bladder branches of the inferior hypogastric plexus). Recognizing the pelvic splanchnic nerves in the caudal parametrium and the isolation of the bladder branches of the inferior hypogastic plexus requires meticulous preparation of the caudal part of the ventral parametrium.

Three-Dimensional Modelization of the Female Human Inferior Hypogastric Plexus: Implications for Nerve-Sparing Radical Hysterectomy

2018 ◽  
Vol 84 (2) ◽  
pp. 196-203 ◽  
Author(s):  
Vincent Balaya ◽  
Fabien Guimiot ◽  
Jean-François Uhl ◽  
Charlotte Ngo ◽  
Myriam Delomenie ◽  
...  
Keyword(s):  
Radical Hysterectomy ◽  
Three Dimensional ◽  
Nerve Sparing ◽  
Inferior Hypogastric Plexus ◽  
Hypogastric Plexus

A systematic nerve-sparing radical hysterectomy technique in invasive cervical cancer for preserving postsurgical bladder function

2005 ◽  
Vol 15 (2) ◽  
pp. 389-397 ◽  
Author(s):  
N. Sakuragi ◽  
Y. Todo ◽  
M. Kudo ◽  
R. Yamamoto ◽  
T. Sato
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Invasive Cervical Cancer ◽  
Uterine Cervical Cancer ◽  
Bladder Function ◽  
Autonomic Nerve ◽  
Nerve Sparing ◽  
Autonomic Nerves ◽  
Bladder Sensation ◽  
Pelvic Splanchnic Nerves

The objective of this study is to describe a technique for preserving the autonomic nerve systematically, including the hypogastric nerves, pelvic splanchnic nerves, and pelvic plexus and its vesical branches, based on anatomic considerations for the autonomic nerves innervating the urinary bladder, in radical hysterectomies and to assess postsurgical bladder function. A nerve-sparing radical hysterectomy was carried out on 27 consecutive patients with uterine cervical cancer treated between 2000 and 2002. The FIGO stages of the disease consisted of 10 stage Ib1, 6 stage Ib2, 3 stage IIa, and 8 stage IIb. The nerve-sparing procedure was successfully completed in 22 of the 27 patients (81.5%) in the study. At 1 year after the operation, bladder symptoms were significantly improved in the nerve-sparing group compared to the non–nerve-sparing group. Urinary incontinence and abnormal (diminished) bladder sensation were observed in three of the five patients (two patients had both symptoms), for whom the nerve-sparing procedure could not be performed, but none of the 22 patients for whom the nerve-sparing procedure was performed had incontinence, and only two patients had abnormal (increased) bladder sensation (P = 0.0034 for incontinence and P = 0.030 for abnormal bladder sensation). The patients' survival was not adversely affected by the nerve-sparing procedure. Although it is still preliminary, the surgical technique described in this report is thought to be effective for preserving bladder function, and thus, the quality of life could be improved for patients with cervical cancer who are treated with a radical hysterectomy. For further evaluation of the efficacy of nerve-sparing radical hysterectomy, a prospective randomized trial needs to be performed.

scholarly journals Identification and injury to the inferior hypogastric plexus in nerve-sparing radical hysterectomy

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Lei Li ◽  
Yalan Bi ◽  
Leiming Wang ◽  
Xinxin Mao ◽  
Bernhard Kraemer ◽  
...  
Keyword(s):  
Radical Hysterectomy ◽  
Immunohistochemical Staining ◽  
Lower Percentage ◽  
Controlled Study ◽  
Control Group ◽  
Nerve Sparing ◽  
Inferior Hypogastric Plexus ◽  
Hypogastric Plexus ◽  
Neural Tissues ◽  
Waterjet Dissection

Abstract Waterjet dissection of the inferior hypogastric plexus (IHP) resulted in a more rapid return of normal urodynamics than blunt dissection (control group) in patients who received laparoscopic nerve-sparing radical hysterectomy (NSRH) in a randomized controlled study. However, the definite reasons for these results were unknown. This subgroup analysis compared the neural areas and impairment in the IHP uterine branches harvested during NSRH as an alternative to the IHP vesical branches between the waterjet and control groups. This study included samples from 30 eligible patients in each group of the trial NCT03020238. At least one specimen from each side of the IHP uterine branches was resected. The tissues were scanned, images were captured, and the neural component areas were calculated using the image segmentation method. Immunohistochemical staining was used to evaluate neural impairment. The control and waterjet groups had similar areas of whole tissues sent for evaluation. However, the control group had significantly fewer areas (median 272158 versus 200439 μm2, p = 0.044) and a lower percentage (median 4.9% versus 3.0%, p = 0.011) of neural tissues. No significant changes in immunohistochemical staining were found between the two groups. For patients with residual urine ≤100 and >100 ml at 14 days after NSRH (42 and 18 patients, respectively), there were significantly different percentages of neural tissues in the resected samples (p < 0.001). Hence, Due to the accurate identification of IHP during NSRH, the waterjet dissection technique achieved better urodynamic results.

Nerve-sparing radical hysterectomy in patients with infiltrative cervical cancer

2016 ◽  
pp. 46-51
Author(s):  
T. Dermenzhy ◽  
◽  
V. Svintitskiy ◽  
S. Nespryadko ◽  
L. Legerda ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Radical Hysterectomy ◽  
Contractile Function ◽  
Major Elements ◽  
Control Group ◽  
Nerve Sparing ◽  
Group I ◽  
Hypogastric Plexus ◽  
Prognostic Indexes

The objective: to improve an effectiveness of therapy and quality of life of patients with infiltrative cervical cancer using radical hysterectomy accomplished with nerve-sparing methodology. Patients and Methods: Ninety patients with histologically verified infiltrative cervical cancer were cured with radical hysterectomy (RHE) in the Department of Oncogynecology of National Cancer Institute (Kyiv, Ukraine) in 2012-2016. The age of the patients was from 26 to 65 years (an average age of 42.61±1.06). The patients were distributed in 2 groups: group I treated with nerve-sparing radical hysterectomy (NSRHE), 45 patients, the main group; group II treated with radical hysterectomy (RHE III), the control group, 45 patients. The prognostic indexes in the groups were similar. Results. NSRHE that included the dissection of cardinal ligament, separation of dorsal and anterior layers of uterovesical ligament allowed separate uterine branch of inferior hypogastric plexus, preserve an innervation of urinary bladder and prevent the malfunction of its contractile function at postoperative period. Conclusion. The data of the urodynamic study using cystomanometry performed at pre- and early operative periods have shown that surgical treatment of patients with infiltrative cervical cancer with preservation of the major elements of pelvic autonomic plexuses allows significantly decrease the rate of postoperative urogenical malfunctions. Key words: nerve-sparing radical hysterectomy, cervical cancer, cystomanometry.

scholarly journals A Concise Paradigm on Radical Hysterectomy: The Comprehensive Anatomy of Parametrium, Paracolpium and the Pelvic Autonomic Nerve System and Its Surgical Implication

Cancers ◽  
2020 ◽  
Vol 12 (7) ◽  
pp. 1839 ◽  
Author(s):  
Mustafa Zelal Muallem ◽  
Thomas Jöns ◽  
Nadja Seidel ◽  
Jalid Sehouli ◽  
Yasser Diab ◽  
...  
Keyword(s):  
Radical Hysterectomy ◽  
Three Dimensional ◽  
Figo Stage ◽  
Autonomic Nerve ◽  
Nerve Sparing ◽  
Anatomical Structures ◽  
Pelvic Autonomic Nerve ◽  
Direct Infiltration ◽  
Autonomic Nerve System ◽  
Nerve System

The current understanding of radical hysterectomy is more centered on the uterus and little is discussed regarding the resection of the vaginal cuff and the paracolpium as an essential part of this procedure. The anatomic dissections of two fresh and 17 formalin-fixed female pelvis cadavers were utilized to understand and decipher the anatomy of the pelvic autonomic nerve system (PANS) and its connections to the surrounding anatomical structures, especially the paracolpium. The study mandates the recognition of the three-dimensional (3D) anatomic template of the parametrium and paracolpium and provides herewith an enhanced scope during a nerve-sparing radical hysterectomy procedure by precise description of the paracolpium and its close anatomical relationships to the components of the PANS. This enables the medical fraternity to distinguish between direct infiltration of the paracolpium, where the nerve sparing technique is no longer possible, and the affected lymph node in the paracolpium, where nerve sparing is still an option. This study gives rise to a tailored surgical option that allows for abandoning the resection of the paracolpium by FIGO stage IB1, where less than 2 cm vaginal vault resection is demanded.

Risk Factors for Persistent Low Bladder Compliance After Radical Hysterectomy

2011 ◽  
Vol 21 (1) ◽  
pp. 167-172 ◽  
Author(s):  
Yasunari Oda ◽  
Yukiharu Todo ◽  
Sharon Hanley ◽  
Masayoshi Hosaka ◽  
Mahito Takeda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Radical Hysterectomy ◽  
Bladder Function ◽  
Autonomic Nerve ◽  
Abdominal Pressure ◽  
Nerve Sparing ◽  
Autonomic Nerves ◽  
Adjuvant Radiation ◽  
Management Protocol ◽  
Bladder Compliance

Introduction:Bladder compliance deteriorates immediately after radical hysterectomy (RH), and low bladder compliance causes upper urinary tract dysfunctions such as progressive hydronephrosis. The aims of this study were to clarify risk factors for persistent low bladder compliance after RH and to propose a postsurgical management protocol for improved recovery of bladder function.Methods:A total of 113 consecutive patients who underwent RH with the intention to preserve the pelvic autonomic nerve system were included in this prospective study. Urodynamic studies were performed according to a planned schedule: presurgery and 1, 3, 6, and 12 months after surgery. Autonomic nerves were preserved at least unilaterally in 95 (84.1%) of the 113 patients, but this was not possible in the remaining 18 patients (15.9%). Postoperative adjuvant radiation therapy (RT) was performed in 14 patients. The relationships between bladder compliance and various clinical factors were investigated using logistic regression analysis. Covariates included age, nerve-sparing procedure, adjuvant RT, and maximum abdominal pressure during the voiding phase. Bladder compliance at 12 months after surgery was used as the dependent variable.Results:Radical hysterectomy with a non-nerve-sparing procedure (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.1-11.0), adjuvant RT (OR, 10.3; 95% CI, 2.5-43.5), and voiding with abdominal pressure at 3 months after surgery (OR, 2.9; 95% CI, 1.1-7.2) were risk factors for persistent low bladder compliance.Conclusions:A nerve-sparing procedure and prohibition of voiding with abdominal strain during the acute and subacute phases after RH resulted in improved recovery of bladder compliance. Adjuvant RT should be avoided in patients who undergo nerve-sparing RH if an alternative postoperative strategy is possible.

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