Nerve-sparing class III radical hysterectomy: a modified technique to spare the pelvic autonomic nerves without compromising radicality

Abstract

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.

Preservation of Autonomic Nerves in Laparoscopic Total Radical Hysterectomy

“…Various authors have established the feasibility of NSRH in stage IIa cervical cancers. 2,4,5,16,[22][23][24] Another drawback of L-NSRH is that it takes more time than conventional LRH. Our mean operative time is 88 minutes 11 for LRH and 160 minutes for L-NSRH.…”

Comparison of Nerve-Sparing Radical Hysterectomy and Radical Hysterectomy: a Systematic Review and Meta-Analysis

“…As a popular surgical technique sparing the pelvic autonomic nerves without compromising radicality, NSRH was reported to have similar clinical safety and extent of resection with RH for early stage cervical cancers treatment [33,37]. As Basaran and colleagues reported that there were neither adequate nor statistically relevant evidence addressing the oncologic safety of NSRH over that of RH, due to the scarcity and heterogeneity of effect estimates in different trials [8].…”

Laparoscopic pelvic anatomy of nerve‐sparing radical hysterectomy

“…The return rate to normal voiding function post-operatively 14 and 21 days was 92.0% and 95.2%, respectively. Our laparoscopic nerve-sparing technique was comparable with open nerve-sparing radical hysterectomy in terms of early recovery of bladder function (Raspagliesi et al, Charoenkwan et al, 2006;Fujii et al, 2007b). In our opinion, previous cadaveric dissection and early recovery of postoperative bladder function could guarantee that suspected nerve fibers dissected via a laparoscopic approach were genuine nerve fibers.…”

“…The early clinical report for nerve-sparing radical hyster- (Trimbos et al, 2001). Most clinical reports have not described these veins (Raspagliesi et al, 2004;Katahira et al, 2005) or depicted them as the inferior vesical vein or the vesical veins without concrete information about the number of vesical veins (Sakuragi et al, 2005;Charoenkwan et al, 2006;Todo et al, 2006;Kato et al, 2007). Fujii S et al insisted that the vesical veins in the posterior leaf of the VUL consisted of middle and inferior vesical veins (Fujii et al, 2007a,b).…”