Nerve-sparing radical hysterectomy—Muallem technique with explanation of parametrium and paracolpium anatomy

2021

Cancers

Self Cite

The current understanding of radical hysterectomy more is centered on the uterus and little is being discussed about the resection of the vaginal cuff and the paracolpium as an essential part of this procedure. This is because that the current classifications of radical hysterectomy are based only on the lateral extent of resection. This way is easier to be understood but does not reflect the anatomical and surgical conception of radical hysterectomy and the three-dimensional ways of tumour spreading, neither meet the need of adjusting the radicality according to the different stages of FIGO classification, which depends—at least in the early stages—on the tumour volume and the infiltration in the vagina (but not on the directly spread in the parametrium). The new classification presented in this paper does not base anymore on the lateral extent of resection only but too on the depth of resection in the small pelvic and the extent of the resected vaginal vault without or with its three-dimensional paracolpium. This classification takes into account the tumour size, stage, localization and infiltration in the vaginal vault and may offer the optimal tool to adjust and tailor the surgery according to these important variables.

Section: Type IV (The Radical Hysterectomy With Radical Upper Colpectomy)mentioning

confidence: 99%

Section: Type IV (The Radical Hysterectomy With Radical Upper Colpectomy)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A New Anatomic and Staging-Oriented Classification of Radical Hysterectomy

2021

Cancers

Self Cite

“…The present study also contends that a poor anatomical understanding of the sympathetic nerves within the boundaries of an infra-renal bilateral template has limited the promulgation of a precise nerve-sparing surgery during such systematic lymph node dissections. Since we already described the precise anatomy of pelvic autonomic nervous system (inferior hypogastric plexus) in our previous studies [ 7 , 8 , 9 ], the principal goal of the present study was to provide the first ever-comprehensive exposition of the anatomy of the female aortic plexus and superior hypogastric plexus and their variations, to elucidate and improve the surgical outcomes of a systematic nerve-sparing lymph node dissection.…”

Section: Introductionmentioning

confidence: 99%

Nerve-Sparing Systematic Lymph Node Dissection in Gynaecological Oncology: An Innovative Neuro-Anatomical and Surgical Protocol for Enhanced Functional Outcomes

Diab²,

Jöns

et al. 2020

Cancers

Self Cite

Whilst systematic lymph node dissection has been less prevalent in gynaecological cancer cases in the last few years, there is still a good number of cases that mandate a systematic lymph node dissection for diagnostic and therapeutic purposes. In all of these cases, it is crucial to perform the procedure as a nerve-sparing technique with utmost exactitude, which can be achieved optimally only by isolating and sparing all components of the aortic plexus and superior hypogastric plexus. To meet this purpose, it is essential to provide a comprehensive characterization of the specific anatomy of the human female aortic plexus and its variations. The anatomic dissections of two fresh and 17 formalin-fixed female cadavers were utilized to study, understand, and decipher the hitherto ambiguously annotated anatomy of the autonomic nervous system in the retroperitoneal para-aortic region. This study describes the precise anatomy of aortic and superior hypogastric plexus and provides the surgical maneuvers to dissect, highlight, and spare them during systematic lymph node dissection for gynaecological malignancies. The study also confirms the utility and feasibility of this surgery in gynaecological oncology.

“…Other studies from our study group confirmed the feasibility of nerve sparing surgery during radical hysterectomy for cervical cancer and explained the precise anatomy of the pelvic autonomic nervous system. [7][8][9] Nerve sparing para-aortic lymph node dissection is feasible and safe in gynecological cancer cases when following the steps outlined in the video for careful dissection of the aortic and superior hypogastric plexus. 1 6 Larger prospective trials are planned to assess the effects of this technique on postoperative functional patient reported outcomes.…”

mentioning

confidence: 99%

Nerve sparing systematic lymph node dissection (para-aortic region): a technique for enhanced functional outcomes after gynecological cancer surgeries

Nasser

Miranda

2022

Int J Gynecol Cancer

Self Cite

Systematic lymph node dissection has become less prevailing in the field of gynecological oncology in the past decade. However, it still remains an essential part of the gynecological oncologist's surgical repertoire as a diagnostic and therapeutic procedure, in particular in gynecological cancer cases. 1 This procedure was associated traditionally with a higher incidence of postoperative bowel, bladder, and sexual dysfunctions. Several studies analyzing quality of life