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.

scholarly journals Proteomic Analysis of Pelvic Autonomic Nerve in Nerve-sparing Radical Hysterectomy for Cervical Carcinoma

2018 ◽  
Vol 15 (4) ◽  
pp. 337-342 ◽  
Author(s):  
YOON HEE LEE ◽  
MIN KYUNG KIM ◽  
HEE YOUNG MOON ◽  
GUN OH CHONG ◽  
HYUN JUNG LEE ◽  
...  
Keyword(s):  
Cervical Carcinoma ◽  
Radical Hysterectomy ◽  
Proteomic Analysis ◽  
Autonomic Nerve ◽  
Nerve Sparing ◽  
Pelvic Autonomic Nerve

scholarly journals Nerve-Sparing Radical Hysterectomy: Kobayashi's Method

2021 ◽  
Author(s):  
Hiroyuki Yoshikawa
Keyword(s):  
Splanchnic Nerve ◽  
Autonomic Nerve ◽  
Nerve Plexus ◽  
Nerve Sparing ◽  
Pelvic Nerve ◽  
The Third ◽  
Medial Side ◽  
Pelvic Splanchnic Nerve ◽  
Autonomic Nerve System ◽  
Nerve System

AbstractAfter Prof. S. Okabayashi introduced Okabayashi Operation in 1921, several surgeons introduced numerous improvements in Japan. One of them is so-called the Tokyo Method which was improved and revised by Dr. Kyusaku Ogino (1950), Prof. Takashi Kobayashi, University of Tokyo (1961, 1970), and Prof. Shoichi Sakamoto, University of Tokyo (1981). The nerve-sparing radical hysterectomy without sacrificing radicality was introduced in 19611 and improved in 1970 by Prof. Kobayashi.2 The autonomic nerve pathway including hypogastric nerve (sympathetic nerve), pelvic splanchnic nerve (parasympathetic nerve), and pelvic nerve plexus as a junction of the two nerves and the branch of the plexus to the bladder (vesical nerve branch) are preserved except in advanced cases. He divided the process of nerve-sparing surgery into four steps for separating the autonomic nerve pathway from adjacent tissues along the pathway consisting of cardinal, sacrouterine, rectouterine/vaginal, and vesicouterine ligaments. The first step is separation of the cardinal ligament (deep uterine vessels) from the pelvic splanchnic nerve. The second step is separation of the medial side of severed cardinal ligament from the pelvic nerve plexus. The first and second steps are performed in the lateral side of the autonomic nerve system. The third step is separation of sacrouterine and rectouterine/vaginal ligaments from hypogastric nerve and pelvic nerve plexus. The third step is necessary for achieving high radicality, namely, for severing the sacrouterine and rectouterine/vaginal ligaments near the rectum without damage to the pelvic nerve plexus. The fourth step is separation of paravaginal tissues and posterior (deep) layer of the vesicouterine ligament from the vesical nerve branches of the plexus. The third and fourth steps are performed in the medial side of the autonomic nerve system.

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

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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