Achieving Type C2 (Type III) Laparoscopic Radical Hysterectomy with Preservation of Nerves: A Possibility

Abstract

Video Objective This video is a demonstration of nerve sparing radical hysterectomy done laparoscopically but what makes it unique is that we could achieve complete parametrectomy which is the most vital step to prevent pelvic recurrences. As we know, the lymphatics follow the veins, removal of parametrium and paracervix on both the sides becomes crucial in achieving complete tumor clearance. Preservation of the nerves helps in the maintenance of bladder, anorectal and sexual functions making the postoperative period better, less morbid & uneventful. In contrast to open surgery, where you have to palpate the tissues to know the extent of dissection of the parametrium, laparoscopy helps us to have an extra edge with pelvic anatomy and magnification of the same. Setting A 70 year old post-menopausal lady had presented to us with white P/V discharge and post-menopausal spotting. Cervical biopsy reported well differentiated squamous cell carcinoma and imaging revealed that there was no extension into the parametrium. Interventions This video highlights the efforts made for hemostasis during the procedure and the relationship of ureters with the uterine vessels on either side. Following the dictum, “fat belongs to the bladder” and “fat belongs to the rectum” that we have always followed, we achieve a bloodless field with preservation of the innervation to bladder and rectum on both the sides. Post-operative course of the patient was unremarkable and she didn't have any bowel and bladder complaints. Conclusion With proficient surgeons, we can achieve complete parametrectomy, equal survival rates and less pelvic recurrences in comparison to open surgery in a rebut to the LACC trial which has taken the world by a storm. It is all about the anatomy and the anatomy of parametrium is the key to achieve a laparoscopic nerve sparing radical hysterectomy with no local recurrences and no lifestyle changes postoperatively.