Laparoscopic nerve-sparing radical hysterectomy: Description of the technique and patients’ outcome

Abstract Objective The radical hysterectomy type three can be accompanied by postoperative morbidity, such as dysfunction of the lower urinary tract with loss of bladder or rectum sensation. We describe the technique of laparoscopic nerve-sparing radical hysterectomy and patient's outcome. Meth...

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Bibliographic Details
Published in:Gynecologic oncology 2010-11, Vol.119 (2), p.198-201
Main Authors: Kavallaris, A, Hornemann, A, Chalvatzas, N, Luedders, D, Diedrich, K, Bohlmann, M.K
Format: Article
Language:English
Subjects:
Adult
Female
Hematology, Oncology and Palliative Medicine
Humans
Hypogastric Plexus - surgery
Hysterectomy - adverse effects
Hysterectomy - methods
Inferior hypogastric nerve
Inferior hypogastric plexus
Laparoscopy
Laparoscopy - adverse effects
Laparoscopy - methods
Lymph Node Excision - adverse effects
Lymph Node Excision - methods
Middle Aged
Neoplasm Staging
Nerve-sparing radical hysterectomy
Obstetrics and Gynecology
Splanchnic nerves
Splanchnic Nerves - surgery
Treatment Outcome
Uterine Cervical Neoplasms - pathology
Uterine Cervical Neoplasms - surgery
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Summary:Abstract Objective The radical hysterectomy type three can be accompanied by postoperative morbidity, such as dysfunction of the lower urinary tract with loss of bladder or rectum sensation. We describe the technique of laparoscopic nerve-sparing radical hysterectomy and patient's outcome. Methods Thirty-two patients underwent laparoscopic nerve-sparing radical hysterectomy with pelvic lymphadenectomy. Both the hypogastric and the splanchnic nerves were identified bilaterally during pelvic lymphadenectomy. Results The median age of the patients was 52 years, and the average operating time was 221 min. There were no intraoperative or postoperative complications considering the nerve-spring radical hysterectomy. Postoperatively, in all patients spontaneous voiding was possible on the third postoperative day with a median residual urine volume of < 50 ml. Conclusions Laparoscopic identification (neurolysis) of the inferior hypogastric nerve and inferior hypogastric plexus is a feasible procedure for trained laparoscopic surgeons who have a good knowledge not only of the retroperitoneal anatomy but also of the pelvic neuro-anatomy as this qualification could prohibit long-term bladder and voiding dysfunction during nerve-sparing radical hysterectomy.
ISSN:0090-8258
1095-6859
DOI:10.1016/j.ygyno.2010.07.020