Technical modification of the nerve-sparing laparoscopy-assisted vaginal radical hysterectomy type 3 for better reproducibility of this procedure☆

Abstract

Objective The goal of this work is to make the technique of nerve-sparing laparoscopy-assisted vaginal radical hysterectomy (LAVRH) type 3 easier and less time consuming. Methods Compared with the original LAVRH type 3, laparoscopic preparation of the cardinal ligament is extended to the transection of the upper part of the rectovaginal ligament. In vaginal approach, the preparation begins not as originally with the bladder pillar and ureter, but with transection of the rest of the rectovaginal ligament followed by dorsal eversion of the uterus and, lastly, transection of the bladder pillar with preparation of the ureters. Results Thirty-two consecutive patients underwent the modified nerve-sparing LAVRH type 3. The mean operative time for the vaginal part of the procedure was 54.3 min, whereas for the original technique for LAVRH type 3, the mean operative time was 143.6 min. Conclusion Prior transection of the rectovaginal ligament in the vaginal approach with dorsal eversion of the uterine fundus makes preparation of the ureter and transection of the bladder pillar easier and significantly less time consuming than in the original LAVRH type 3.