Laparoscopic technique for step-by-step nerve-sparing Okabayashi radical hysterectomy

Sekiyama, Kentaro; Ando, Yukiko; Taga, Atsuko; Kozono, Yuki; Higuchi, Toshihiro; Fujii, Shingo

doi:10.1136/ijgc-2019-000726

Cited by 8 publications

(9 citation statements)

References 3 publications

(4 reference statements)

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“…Fujii and Sekiyama indicated that a step-by-step procedure, which was originally developed based on Okabayashi's radical hysterectomy, can be performed in a class C1 radical hysterectomy where the complete division of both the anterior and posterior leaf of the vesicouterine ligament reveals the bladder branch from the inferior hypogastric plexus and enables the selective division of the uterine branch from the inferior hypogastric plexus. 9,23 Previously published studies suggest that the primary advantage of the nerve-sparing method is reduced postoperative co-morbidities, without it being inferior in terms of tumor control and overall survival. Furthermore, patients who underwent an LRH experienced a shorter recovery time for bladder function than those who undertook open surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The uterus is pulled‐up using 5 mm grasping forceps that are inserted under the left costal arch; however, a uterine manipulator is not used to prevent the transmission of cancer cells into the abdominal cavity. In this way, we detect several vesicouterine vessels which are then isolated, ligated, and cut following a step‐by‐step procedure 9,23 . After we isolate the bladder branch and the uterine branch from the inferior hypogastric nerve and the pelvic splanchnic nerve plexus, we then cut only the uterine branch.…”

Section: Methodsmentioning

confidence: 99%

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Postsurgical urodynamic study of total laparoscopic nerve‐sparing radical hysterectomy for uterine cervical cancer

Terada

Tanaka

et al. 2022

J of Obstet and Gynaecol

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Aim: To evaluate the impact on urodynamic results between the laparoscopic nerve-sparing radical hysterectomy (LRH) following a step-by-step procedure and abdominal nerve-sparing radical hysterectomy (ARH) for patients with uterine cervical cancer. Methods: This retrospective study enrolled 76 patients with cervical cancer: 35 in the LRH group and 41 in the ARH group. We analyzed their postoperative bladder function in a urodynamics study and examined the volume of resected pelvic nerves contained in parametrial sections using S-100 antibody staining. Results: Estimated blood loss and hospital stay after operation for the LRH group were significantly better than those in the ARH group (p < 0.0001). As well, the number of harvested lymph nodes was significantly higher in the LRH group (p = 0.044). There was no difference in perioperative complications between the two groups in this study. The 5-year disease-free survival rates and overall survival rates were 91.2% and 94.0% in the LRH group and 87.8% and 95.1% in the ARH group, both respectively. Although the median residual urine volume were no statistical differences between the LRH group and the ARH group, the recovery of postoperative bladder function (uroflowmetry) in the LRH group rapidly reached presurgery levels at 1 month, and the LRH group had a smaller number of s-100 antibody stained nerves contained the parametrial sections. Conclusion:We demonstrated that LRH following a step-by-step procedure could achieve a higher level of prevention of damage to the bladder branch of the pelvic splanchnic nerve plexus and thus restore bladder function more rapidly.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Postsurgical urodynamic study of total laparoscopic nerve‐sparing radical hysterectomy for uterine cervical cancer

Terada

Tanaka

et al. 2022

J of Obstet and Gynaecol

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“…The vaginal cuff can be closed by intracorporeal or transvaginal approaches. Using the intracorporeal approach, the techniques of clamping the vagina with a bulldog clip or a surgical stapler were reported 6,7 . The paracolpium should be divided completely before clamping the vagina, but it is not easy.…”

Section: Discussionmentioning

confidence: 99%

A simple technique of vaginal cuff closure to prevent tumor cell spillage in laparoscopic radical hysterectomy for uterine cervical cancer

Deura

Kanamori

Nagasawa

et al. 2021

Asian J Endoscop Surgery

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Introduction The Laparoscopic Approach to Cervical Cancer (LACC) trial, a prospective randomized phase III clinical trial reported in 2018, unexpectedly showed inferior oncologic outcomes in laparoscopic radical hysterectomy (LRH) for cervical cancer compared with those in open surgery. It was proposed that the spillage of tumor cells into the peritoneal cavity might cause the inferiority of LRH. It has been suggested, based on retrospective studies, that transvaginal closure of the vaginal cuff before the colpotomy part of the surgery may prevent this. Materials and Surgical Technique Before starting colpotomy, we closed the vaginal cuff transvaginally. After the assessment of the cutline of the vagina, the vaginal mucosa is pulled at the eight sites using the sutures. The four pairs of sutures on the diagonal line are ligated. A purse string suture is additionally placed on the vaginal mucosa to close the vaginal cuff completely. After that, we start the intracorporeal colpotomy using a vaginal pipe. Discussion Our technique is simple and quick. The blood loss during the transvaginal procedures is minimal. The use of the vaginal pipe helps keep the vaginal cuff closed during the colpotomy. Our technique may be an alternative to the conventional approach closing the vaginal cuff.

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“…As a surgical procedure for the clinical treatment of patients with early cervical cancer, LRH has multiple advantages such as less intraoperative blood loss, less trauma, and rapid postoperative recovery compared with traditional open surgery without compromising the extend of surgical resection [ 26 ]. It has been discovered that the minimally invasive advantages of laparoscopy of laparoscopic magnification enable identification of the pelvic view and identify the pelvic autonomic nerves and resulting in its preservation [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…It has been discovered that the minimally invasive advantages of laparoscopy of laparoscopic magnification enable identification of the pelvic view and identify the pelvic autonomic nerves and resulting in its preservation [ 27 ]. The results of this study have suggested that LNSRH takes a longer time compared with LRH, mainly because this operation requires the surgeon to be meticulous, and the pelvic autonomic nerve needs to be carefully identified and isolated during the operation to protect the pelvic autonomy nerve [ 26 ]. The duration of LNSRH is longer than LRH, but with advancement of operative skills, the procedure can be optimized and the operation time can be shortened [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic nerve‑sparing radical hysterectomy for the treatment of cervical cancer: a meta-analysis of randomized controlled trials

Guo

et al. 2021

World J Surg Onc

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Background The effects and safety of laparoscopic nerve‑sparing radical hysterectomy (LNSRH) and laparoscopic radical hysterectomy (LRH) in cervical cancer treatment remain unclear. This article aims to evaluate the role of LNSRH versus LRH in the treatment of cervical cancer. This is because the updated meta-analysis with synthesized data may provide more reliable evidence on the role of LNSRH and LRH. Methods We searched Pubmed et al. databases for randomized controlled trials (RCTs) involving laparoscopic nerve‑sparing radical hysterectomy (LNSRH) and laparoscopic radical hysterectomy (LRH) for cervical cancer treatment from the inception of databases to June 15, 2021. The RevMan 5.3 software was used for data analyses. This meta-analysis protocol had been registered online (available at: https://inplasy.com/inplasy-2021-9-0047/). Results Thirteen RCTs involving a total of 1002 cervical cancer patients were included. Synthesized results indicated that the duration of surgery of the LNSRH group was significantly longer than that of the LRH group [SMD 1.11, 95% CI (0.15 ~ 2.07), P = 0.02]. The time to intestinal function recovery [SMD −1.27, 95% CI (−1.84 ~ −0.69), P < 0.001] and the time to postoperative urinary catheter removal of the LNSRH group [SMD −1.24, 95% CI (−1.62 ~ −0.86), P < 0.001] were significantly less than that of the LRH group. There were no significant differences in the estimated blood loss [SMD 0.10, 95% CI (−0.14 ~ 0.34), P = 0.41], the length of parauterine tissue resection [SMD −0.10, 95% CI (−0.25 ~ 0.05), P = 0.19], length of vaginal excision [SMD 0.04, 95% CI (−0.26 ~ 0.34), P = 0.78], and incidence of intraoperative adverse events [RR 0.97, 95% CI (0.44 ~ 2.13), P = 0.94] between the LNSRH group and the LRH group. Conclusions LNSRH significantly results in earlier bladder and bowel function after surgery. Limited by sample size, LNSRH should be considered with caution in the future.

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Laparoscopic technique for step-by-step nerve-sparing Okabayashi radical hysterectomy

Cited by 8 publications

References 3 publications

Postsurgical urodynamic study of total laparoscopic nerve‐sparing radical hysterectomy for uterine cervical cancer

Postsurgical urodynamic study of total laparoscopic nerve‐sparing radical hysterectomy for uterine cervical cancer

A simple technique of vaginal cuff closure to prevent tumor cell spillage in laparoscopic radical hysterectomy for uterine cervical cancer

Laparoscopic nerve‑sparing radical hysterectomy for the treatment of cervical cancer: a meta-analysis of randomized controlled trials

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