An Update of Anatomical References in Total Laparoscopic Radical Hysterectomy: From Surgical Anatomy to Anatomical Surgery

Abstract

Study Objective To evaluate laparoscopic dissection methodology for exposing the anatomical references necessary to achieve total laparoscopic radical hysterectomy. Design Retrospective single-center study. Video records of total laparoscopic radical hysterectomy were reviewed. The classic works of surgical anatomy and the most recent works on pelvic anatomy were used to elaborate anatomical references. (Canadian Task Force classification II-1). Setting Son Llátzer General Hospital of Palma de Mallorca, Spain. Interventions Videorecords of 40 consecutive total laparoscopic radical hysterectomy for cervical cancer were reviewed. Measurements and Main Results The surgical maneuvers of total laparoscopic radical hysterectomy necessary for identification of the anatomical references are described. Conclusions Abdominal radical hysterectomy entails a series of surgical maneuvers with potential risk of bleeding and/or damage to pelvic structures. Many of these risks can be prevented, because the laparoscope enables precise surgical maneuvers in zones of difficult abdominal access. It is necessary to renew the classic concepts of surgical anatomy to adapt them to the operative mechanics of laparoscopy, which are closer to the characteristics of microsurgery than abdominal surgery.