TY - JOUR
T1 - Classical and nerve-sparing radical hysterectomy: An evaluation of the risk of injury to the autonomous pelvic nerves
AU - Ercoli, Alfredo
AU - Delmas, V.
AU - Gadonneix, P.
AU - Fanfani, Francesco
AU - Villet, R.
AU - Paparella, Pierluigi
AU - Mancuso, Salvatore
AU - Scambia, Giovanni
PY - 2003
Y1 - 2003
N2 - Radical hysterectomy represents the treatment of choice for FIGO stage IA2-IIA cervical cancer. It is associated with several serious complications such as urinary and anorectal dysfunction due to surgical trauma to the autonomous nervous system. In order to determine those surgical steps involving the risk of nerve injury during both classical and nerve-sparing radical hysterectomy, we investigated the relationships between pelvic fascial, vascular and nervous structures in a large series of embalmed and fresh female cadavers. We showed that the extent of potential denervation after classical radical hysterectomy is directly correlated with the radicality of the operation. The surgical steps that carry a high risk of nerve injury are the resection of the uterosacral and vesicouterine ligaments and of the paracervix. A nerve-sparing approach to radical hysterectomy for cervical cancer is feasible if specific resection limits, such as the deep uterine vein, are carefully identified and respected. However, a nerve-sparing surgical effort should be balanced with the oncological priorities of removal of disease and all its potential routes of local spread.
AB - Radical hysterectomy represents the treatment of choice for FIGO stage IA2-IIA cervical cancer. It is associated with several serious complications such as urinary and anorectal dysfunction due to surgical trauma to the autonomous nervous system. In order to determine those surgical steps involving the risk of nerve injury during both classical and nerve-sparing radical hysterectomy, we investigated the relationships between pelvic fascial, vascular and nervous structures in a large series of embalmed and fresh female cadavers. We showed that the extent of potential denervation after classical radical hysterectomy is directly correlated with the radicality of the operation. The surgical steps that carry a high risk of nerve injury are the resection of the uterosacral and vesicouterine ligaments and of the paracervix. A nerve-sparing approach to radical hysterectomy for cervical cancer is feasible if specific resection limits, such as the deep uterine vein, are carefully identified and respected. However, a nerve-sparing surgical effort should be balanced with the oncological priorities of removal of disease and all its potential routes of local spread.
KW - Nerve-sparing
KW - Pelvic plexus
KW - Pelvic splanchnic nerves
KW - Radical hysterectomy
KW - Nerve-sparing
KW - Pelvic plexus
KW - Pelvic splanchnic nerves
KW - Radical hysterectomy
UR - http://hdl.handle.net/10807/167818
U2 - 10.1007/s00276-003-0137-7
DO - 10.1007/s00276-003-0137-7
M3 - Article
SN - 0930-1038
VL - 25
SP - 200
EP - 206
JO - Surgical and Radiologic Anatomy
JF - Surgical and Radiologic Anatomy
ER -