The Swift operation: a modification of the Leiden nerve-sparing radical hysterectomy

Abstract

In 2002, our group introduced an operation to avoid damage to the pelvic autonomous nerves during radical hysterectomy that proved to be feasible, effective and safe. During the last five years, we have adapted our surgical technique to make this procedure easier and safer in terms of radicality. We report on the changes in the surgical approach and the results in the first 15 consecutive patients. The Swift operation is more radical in the area of the uterosacral ligaments than the original operation, and it dissects the hypogastric nerve free under direct vision. In

Nerve-sparing radical hysterectomy versus conventional radical hysterectomy in early-stage cervical cancer. A systematic review and meta-analysis of survival and quality of life

“…This strongly supports and strengthens our conclusions and indicates that the results of our review are valid. There are many authors who have published just as many different surgical procedures to selectively spare the autonomic nerves in the small pelvis [3,8,[64][65][66]. Especially the extent to which the autonomic nerves should be selectively dissected from the vesico-cervical ligament is under debate [64].…”

“…Especially the extent to which the autonomic nerves should be selectively dissected from the vesico-cervical ligament is under debate [64]. We decided not to take the surgical procedure into account since the different techniques all identify and selectively lateralise the hypogastric plexus when dissecting the sacro-uterine ligament and stay above the deep uterine vein to spare the splanchnic nerves [2,3,65]. When the deep uterine vein is considered as the ventral margin of the dissection of the parametrium one may argue that the parametrectomy is less radical and consequently not adequate.…”

Embryologically Based Resection of Cervical Cancers: A New Concept of Surgical Radicality

“…Inspired by this work, Trimbos et al [23] from Leiden University, Netherlands, developed the Swift operation, a modified nerve sparing radical hysterectomy. This surgery is called Swift because the specimen after surgery resembles a swift bird.…”

Long-Term Oncological Outcome After Conventional Radical Hysterectomy Versus 2 Nerve-Sparing Modalities for Early Stage Cervical Cancer

“…7 Höckel et al 9 described new insights on tumor spread of cervical cancer cells showing that this is not a random process but follows a certain morphogenetic unit. This inspired us to develop an adaptation to this technique: the Swift operation, 10 which resembles the total mesometrial resection as developed and advocated by Höckel et al 9 From 2006 onward, the Swift operation was used as the preferred procedure in all early stage cervical cancer patients at the LUMC.…”

“…And third, the lateral leaf of the vesicouterine ligament is only resected when it is necessary to obtain radically free surgical margins in this area. 10 By being more radical around the uterosacral ligaments and parametria and having better visibility at the hypogastric nerves, the Swift operation is thought to be an improvement of the LNSRH in sparing the autonomic nerve system. 10 In this cohort study, we analyzed whether the Swift procedure could be superior to the LNSRH in terms of oncological outcome.…”