Conventional Radical Hysterectomy Research Articles

Comparison of the survival outcomes of laparoscopic, abdominal and gasless laparoscopic radical hysterectomy for early-stage cervical cancer: trial protocol of a multicenter randomized controlled trial (LAGCC trial).

Radical hysterectomy (RH) is considered a cornerstone in the treatment of early-stage cervical cancer. However, the debate surrounding the optimal surgical approach, whether minimally invasive or open surgery, remains controversial. The objective of this trial is to evaluate the survival outcomes of cervical cancer patients who undergo different surgical approaches. This study is designed as a prospective, multicenter, open, parallel, and randomized controlled trial. A total of 500 patients diagnosed with stage IA1 with LVSI, IA2, IB1, or IB2 (2018 FIGO) will be recruited. Recruitment of participants started in November 2020. The participants will be randomly assigned to one of three groups: conventional laparoscopic RH, gasless laparoscopic RH, or abdominal RH. The primary endpoint of this trial is the 2-year disease-free survival (DFS) rate. The secondary endpoints will include the 2-year overall survival (OS) rate, 5-year DFS/OS, recurrence rates, operation time, intraoperative blood loss, surgery-related complications, and impact on quality of life (QoL). We expect this trial to provide compelling and high-quality evidence to guide the selection of the most appropriate surgical approach for early-stage cervical cancer. Chinese Clinical Trial Register, identifier ChiCTR2000035515.

Robot-assisted versus conventional laparoscopic radical hysterectomy in cervical cancer stage IB1.

Objective: The aim of this study was to compare survival outcomes of robot-assisted laparoscopic radical hysterectomy (RRH) and conventional laparoscopic radical hysterectomy (LRH) in cervical cancer stage IB1. Method: This is a retrospective study of patients with cervical cancer stage IB1 who surgically treated by either RRH or LRH. Oncologic outcomes of the patients were compared according to surgical approach. Results: In total, 66 and 29 patients were assigned to LRH and RRH groups. All patients had stage IB1 disease (FIGO 2018). Intermediate risk factors (tumor size, LVSI, and deep stromal invasion), proportion of patients receiving adjuvant therapy (30.3% vs. 13.8%, p = 0.09), and median follow-up time (LRH, 61 months; RRH, 50 months; p=0.085) did not differ significantly between the two groups. The recurrence rate was higher in the LRH group; however, there was no significant difference between the two groups (p=0.250). DFS (55.4 vs 48.2 months, p = 0.250), and OS (61.2 vs 50.0 months, p = 0.287) were similar between the LRH and RRH groups. Conclusion: In patients with a tumor size < 2 cm, the recurrence rate was lower in RRH group; however, there was no significant difference. Further large-scale RCTs and clinical studies are required to provide relevant data.

Solution to prevent tumor spillage in minimally invasive radical hysterectomy using the endoscopic stapler for treating early-stage cervical cancer: Surgical technique with video

Gynecologic oncologists had originally preferred minimally invasive surgery (MIS) over laparotomic surgery for patients with early-stage cervical cancer until the Laparoscopic Approach to Cervical Cancer (LACC) trial reported a worse prognosis and more loco-regional recurrence in patients treated with MIS. Although some controversy remains, experts suggested that tumor cell spillage and aggravation may have been caused by intra-corporeal colpotomy, usage of uterine elevators, maintenance of Trendelenburg position, and tumor irritation by capnoperitoneum during surgery. Thus, we introduce a surgical procedure with some steps added to the conventional MIS radical hysterectomy for preventing tumor spillage during the surgery, which is currently being evaluated in terms of safety and efficacy through a prospective, multicenter, single-arm, phase II study, entitled “Safety of laparoscopic or robotic radical surgery using endoscopic stapler for inhibiting tumor spillage of cervical neoplasms (SOLUTION trial: NCT04370496)”.

The Diagnosis of Perineural Invasion: A Crucial Factor in Novel Algorithm of Coexistence of Conventional and Nerve-Sparing Radical Hysterectomy.

Nerve-sparing radical hysterectomy (NSRH) was introduced to mitigate adverse effects associated with conventional radical hysterectomy (CRH) in cervical cancer. However, the introduction of NSRH was compromised by possible existence of perineural invasion (PNI). Additionally, the coexistence of NSRH and CRH is currently the fact. The aim of the study was to review the literature and attempt to construct a novel and preliminary PNI diagnostic algorithm that would establish the coexistence of NSRH and CRH in one system of early-stage cervical cancer (ESCC) surgical treatment. This algorithm takes into account the PNI risk factors and current and future diagnostic methods such as imaging and biopsy.

Open nerve-plane sparing radical hysterectomy in locally advanced cervical cancer: evaluation on efficacy and long-term survival outcomes

Objective: To evaluate the security and clinical outcomes of open nerve-plane sparing radical hysterectomy (NPSRH) for operable locally advanced cervical cancer, compared with conventional radical hysterectomy (CRH). Methods: All 389 cases with International Federation of Gynecology and Obstetrics (FIGO, 2009) stage Ⅰb2 and Ⅱa2 cervical cancer were retrospectively analyzed in Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences between January 2008 and December 2014. Of all the patients, 69 cases underwent laparotomic NPSRH, and other 320 cases underwent CRH. Patients' general characteristics and intraoperative parameters were evaluated between the two groups. Basic clinical and pathological informations between the two groups were matched. After median 82 months' follow-up,disease-free survival (DFS), overall survival (OS), and postoperative recovery of bladder function were compared between the two groups. Results: (1) Compared to CRH group, NPSRH group had less intraoperative bleeding [(366±302) vs (457±301) ml; t=2.305, P=0.022], and a little bit longer operation time [(262±51) vs (245±52) minutes; t=2.621, P=0.009]. (2) Compared to CRH group, NPSRH group had shorter duration of urethral catheterization [(11±9) vs (16±7) days; t=3.906, P<0.01], and better postoperative bladder sensation and function in one year (6.1% vs 16.0%; χ2=4.418, P=0.036). (3) The 5-year DFS rate and 5-year OS rate of all patients were 89.6% and 89.9%, respectively. Either preserving pelvic autonomic nerves or not had little effect on the 5-year DFS rate (NPSRH vs CRH: 90.9% vs 89.4%; P=0.714) or on 5-year OS rate (NPSRH vs CRH: 90.0% vs 89.9%; P=0.910) for locally advanced cervical cancer. Univariate analysis showed that lymphatic vascular space infiltration (LVSI) and pelvic lymphatic metastasis were significantly correlated with prognosis (P<0.05). Multivariate analysis showed that pelvic lymphatic metastasis was the independent prognostic factor of 5-year DFS rate (HR=1.31, 95%CI: 1.01-1.68, P=0.040) as well as 5-year OS rate (HR=1.30, 95%CI: 1.01-1.67, P=0.046) for locally advanced cervical cancer. Conclusion: Open NPSRH is feasible for patients with locally advanced cervical cancer, which could improve both short-term and long-term bladder function, and is not a risk factor for the prognosis of patients.

Total laparoscopic vs. conventional open abdominal nerve-sparing radical hysterectomy: clinical, surgical, oncological and functional outcomes in 301 patients with cervical cancer.

ObjectiveTotal laparoscopic nerve-sparing radical hysterectomy (TL-NSRH) has been considered a promising approach, however, surgical, clinical, oncological and functional outcomes have not been systematically addressed. We present a large retrospective multi-center experience comparing TL-NSRH vs. open abdominal NSRH (OA-NSRH) for early and locally-advanced cervical cancer, with particular emphasis on post-surgical pelvic function.MethodsAll consecutive patients who underwent class C1-NSRH plus bilateral pelvic + para-aortic lymphadenectomy for stage IA2–IIB cervical cancer at 4 Italian gynecologic oncologic centers (Negrar, Varese, Bologna, Avellino) were enrolled. Patients were divided into TL-NSRH and OA-NSRH groups and were investigated with preoperative questionnaires on urinary, rectal and sexual function. Postoperatively, patients filled a questionnaire assessing quality of life, taking into account sexual function and psychological status. Oncological outcomes were analyzed using Kaplan-Meyer method.Results301 consecutive patients were included in this study: 170 in the TL-NSRH group and 131 in the OA-NSRH group. Patients in the OA-NSRH group were more likely to experience urinary incontinence and (after 12-months follow-up) urinary retention. No patient in the TL-NSRH group vs. 5 (5.5%) in the OA-NSRH group had complete urinary retention (at the >24-month follow-up [p=0.02]). A total of 20 (11.8%) in the TL-NSRH and 11 (8.4%) patients in the OA-NSRH had recurrence of disease (p=0.44) and 14 (8.2%) and 9 (6.9%) died of disease during follow-up, respectively (p=0.83).ConclusionOur study shows that TL-NSRH is feasible, safe and effective and conjugates adequate radicality and improvement in post-operative functional outcomes. Oncological outcomes of laparoscopic procedures deserve further investigation.

A Retrospective Comparison of the Outcomes of Laparoscopic and Open Radical Hysterectomy for Early and Advanced Cancer of the Cervix, in the Post-LACC Era

Laparoscopic radical hysterectomy (LRH) is being performed for cervical cancer treatment in many centres worldwide for last three decades. Since the results of LACC trial came out, a number of centres are reverting back to conventional open radical hysterectomy. In this study, we compared the surgical and oncological outcomes of LRH and ORH performed in our centre. This is a retrospective study in which we included 171 cancer cervix patients who underwent LRH or ORH in our centre from December 2012 to march 2018. We included FIGO (2009 edition) stages IB1 to IIB cervical cancer. Patients with stages IB2, IIA2 and IIB received neo-adjuvant therapy with either chemotherapy alone or concurrent chemoradiotherapy. Their demography, surgical morbidity, recurrence and survival data were collected and analysed. The survival data for patients who had upfront surgery and those with surgery after neo-adjuvant therapy were compared separately. There was significant difference between the two arms only in the estimated blood loss during surgery (p = 0.03). The duration of surgery, post-operative length of hospital stay and lymph node harvest were similar between LRH and ORH. The incidence of intraoperative bladder injuries (p = 0.1) and post-operative vesico-vaginal and uretero-vaginal fistulas were higher (p = 0.3) in LRH; there was no statistical significance. There was a non-significant increase in the post-operative bladder dysfunction rates in the LRH arm. The progression-free survival and overall survival were similar (both in upfront surgery and surgery after neo-adjuvant therapy) for LRH and ORH. Our results are analogous to some of the previous retrospective studies showing comparable oncological outcomes of LRH to conventional open surgery. LRH confers the benefits of less blood loss, early recovery and shorter hospital stay. Further randomised trials with modifications in techniques are needed, and minimally invasive surgery should prosper.

Effectiveness and Long-term Outcomes of Nerve-Sparing Radical Hysterectomy for Cervical Cancer.

Radical hysterectomy (RH) is a type of radical surgery for cervical cancer. Urinary dysfunction due to RH worsens postoperative quality of life of patients with cervical cancer. Nerve-sparing RH (NSRH) technique has been used as an effective means to conserve urinary function. However, few reports have examine long-term outcomes after NSRH. This study describes the details and long-term outcomes of our nerve-sparing technique. Sixty-one patients underwent radical hysterectomy in a 5-year period during which nerve-sparing technique was introduced; of these, 31 patients underwent NSRH and 30 underwent conventional RH. We retrospectively examined their medical records and compared postoperative urinary function and treatment outcomes between these two groups. The median time required for urinary residual volume to fall to ≤50 mL after removal of the urinary catheter was 6 days (range, 2-20 days) in the NSRH group and 13.5 days (range, 3-46 days) in the RH group. The results were significantly better in the NSRH group (p < 0.05). The mean follow-up period was 2456.3 days (range, 48-4,213 days). Analysis of curability revealed no significant difference between the two groups in local recurrence or long-term survival rates. The 5-year survival rate was 0.861 in the NSRH group and 0.782 in the RH group; the 10-year survival rate was 0.861 in the NSRH group and 0.679 in the RH group. NSRH significantly improved postoperative urinary function without worsening local recurrence rates or long-term outcomes.

Separate lateral parametrial lymph node dissection improves detection rate of parametrial lymph node metastasis in early-stage cervical cancer: 10-year clinical evaluation in a single center in China.

ObjectiveTo investigate the clinical significance of separate lateral parametrial lymph node dissection (LPLND) in improving parametrial lymph node (PLN) and its metastasis detection rate during radical hysterectomy for early-stage cervical cancer.MethodsFrom July 2007 to August 2017, 2,695 patients with cervical cancer in stage IB1−IIA2 underwent radical hysterectomy were included. Of these patients, 368 underwent separate dissection of PLNs using the LPLND method, and 2,327 patients underwent conventional radical hysterectomy (CRH). We compared the surgical parameters, PLN detection rate and PLN metastasis rate between the two groups.ResultsCompared with CRH group, the rate of laparoscopic surgery was higher (60.3% vs. 15.9%, P<0.001), and the blood transfusion rate was lower (19.0%vs. 29.0%, P<0.001) in the LPLND group. PLNs were detected in 356 cases (96.7%) in the LPLND group, and 270 cases (11.6%) in the CRH group (P<0.001), respectively. The number of PLNs detected in the LPLND group was higher than that in the CRH group (median 3vs. 1, P<0.001). The PLN metastases were detected in 25 cases (6.8%) in the LPLND group, and 18 cases (0.8%) in the CRH group (P<0.001), respectively. In multivariable analysis, LPLND is an independent factor not only for PLN detection [odds ratio (OR)=228.999, 95% confidence interval (95% CI): 124.661−420.664; P<0.001], but also for PLN metastasis identification (OR=10.867, 95% CI: 5.381−21.946; P<0.001). ConclusionsLPLND is feasible and safe. The surgical method significantly improves the detection rate of PLN and avoids omission of PLN metastasis during radical hysterectomy for early-stage cervical cancer.

Efficacy of nerve-sparing radical hysterectomy vs. conventional radical hysterectomy in early-stage cervical cancer: A systematic review and meta-analysis.

The aim of the present study was to compare the oncological outcome of nerve-sparing radical hysterectomy (NSRH) and conventional radical hysterectomy (CRH) for early-stage cervical cancer using a meta-analysis. A systematic review and meta-analysis was conducted, including 4 randomized controlled trials (RCT), 8 case-control and 11 comparative cohort studies comparing the morbidity, pelvic dysfunctions and oncological outcome between the two surgical methods. A total of 23 studies were included in this meta-analysis. The studies reported data of patients affected by cervical cancer; were written in English; included ≥20 patients; and reported data of patients with a comparison of clinical outcomes between NSRH and CRH. Data were extracted and risk of bias was assessed by four independent reviewers. A total of 1,796 patients were included: 884 patients (49.2%) undergoing NSRH and 912 (50.8%) undergoing CRH. The meta-analyses were conducted using Review Manager version 5.3 software, which is designed for conducting Cochrane reviews. As regards perioperative parameters, NSRH was found to be associated with a lower intraoperative blood loss and a shorter length of hospital stay in comparison with CRH. Patients undergoing NSRH experienced lower incidence of urinary, colorectal and sexual dysfunction compared with patients undergoing CRH. However, the resected parametrial width was favorable in patients with CRH, suggesting that NSRH was inferior to CRH in terms of radicality. The 5-year disease-free and overall survival rates were similar between the two groups. In this systematic review and meta-analysis, the collected data to date demonstrated that the nerve-sparing approach guarantees minimized surgical-related pelvic dysfunction, with similar oncological outcomes as CRH. However, further RCTs should be conducted to confirm the superiority and safety of NSRH.

2794 Nerve Sparing Radical Hysterectomy Versus Conventional Radical Hysterectomy in Early-Stage Cervical Cancer: A Systematic Review And Meta-Analysis

Study Objective To compare the oncologic outcome of nerve-sparing radical hysterectomy and conventional radical hysterectomy through meta-analysis. Design A systematic review and meta-analysis of 4 randomized controlled trials, 8 case-control, and 11 comparative cohort studies that compared the morbidity and pelvic dysfunctions, and oncologic outcomes in both surgical methods. Setting A total of 23 studies were included in this meta-analysis; included studies reporting data of patients affected by cervical cancer; included studies written in English language; included studies including ≥20 patients; included studies reporting data of patients with a comparison of clinical outcomes between nerve-sparing radical hysterectomy and conventional radical hysterectomy. Data were extracted and risk of bias was assessed by four independent reviewers. Patients or Participants Overall, 1769 patients were included: 884 (49.2%) and 912 (50.8%) patients undergoing nerve-sparing radical hysterectomy and conventional radical hysterectomy, respectively. Interventions The meta-analyses were conducted using software designed for composing Cochrane reviews (Review Manager Version 5.3). Measurements and Main Results Looking at perioperative parameters, we observed that nerve-sparing radical hysterectomy was associated with a lower intraoperative blood loss and a shorter length of hospital stay in comparison with conventional radical hysterectomy. Patients undergoing nerve-sparing radical hysterectomy experienced lower urinary, colorectal, and sexual dysfunctions than patients undergoing conventional radical hysterectomy. Among parametric factors, resected parametrial widths was favorable in patients with conventional radical hysterectomy. This result suggests that nerve-sparing radical hysterectomy is inferior to conventional radical hysterectomy in its radicality. The 5-year disease free survival and 5-year overall survival rates were similar between groups. Conclusion The collected data up to now demonstrated that the nerve-sparing approach guarantees minimized surgical-related pelvic dysfunctions, similar oncologic outcomes as conventional radical hysterectomy. However, because of the low quality of the articles included, more evidence is needed. Further RCTs should be conducted to strengthen the superiority and safety of NSRH.

Radical Hysterectomy: Efficacy and Safety in the Dawn of Minimally Invasive Techniques

To analyze the effect that the introduction of minimally invasive procedures has had on surgical and oncologic outcomes when compared with conventional open radical hysterectomy (ORH) in a national reference cancer after 17 years of experience in radical hysterectomy. A prospective controlled study (Canadian Task Force classification II-2). A university teaching hospital. All patients who underwent radical hysterectomy as primary treatment for cervical cancer in our institution between May 1999 and June 2016, with a total of 188 patients. Patients underwent ORH or minimally invasive surgery (MIS) (i.e., laparoscopic or robotically assisted radical hysterectomy). Seventy-six patients underwent ORH, 90 laparoscopic radical hysterectomy, and 22 robotically assisted radical hysterectomy. Blood loss and hospital stay were inferior in the MIS group (p <.0001). The laparotomic group presented shorter operation times (p = .0001). With a median follow-up of 112.4 months, a total of 156 patients (83%) were alive and free of disease at the time of the data analysis. Overall survival was higher in the MIS group when compared with the ORH group (91 vs 78.9, p = .026). There were no differences regarding recurrence rates between the surgical approaches. With 1 of the largest follow-up periods in the literature, this study provides added evidence that MIS could become the preferable surgical approach for early-stage cervical cancer since it appears to reduce morbidity without affecting oncologic results.

Oncologic effectiveness of nerve-sparing radical hysterectomy in cervical cancer.

ObjectiveNerve-sparing radical hysterectomy (NSRH) was introduced with the aim to reduce pelvic dysfunctions related to conventional radical hysterectomy (RH). Here, we sought to assess the effectiveness and safety of NSRH in a relatively large number of the patients of cervical cancer (CC) patients undergoing either primary surgery or neoadjuvant chemotherapy (NACT) followed by surgery.MethodsOutcomes of consecutive patients undergoing NSRH and of a historical cohort of patients undergoing conventional RH were retrospectively reviewed.ResultsThis study included 325 (49.8%) and 327 (50.2%) undergoing NSRH and RH, respectively. Via a multivariable model, nodal status was the only factor predicting for DFS (hazard ratio [HR]=2.09; 95% confidence interval [CI]=1.17–3.73; p=0.01). A trend towards high risk of recurrence was observed for patients affected by locally advanced cervical cancer (LACC) undergoing NACT followed by surgery (HR=2.57; 95% CI=0.95–6.96; p=0.06). Type of surgical procedures (NSRH vs. RH) did not influence risk of recurrence (p=0.47). Similarly, we observed that the execution of NSRH rather than RH had not a detrimental effect on OS (HR=1.19; 95% CI=0.16–9.01; p=0.87). Via multivariable model, no factor directly correlated with OS. No difference in early complication rates was observed between the study groups. Conversely, a significant higher number of late complications was reported in RH versus NSRH groups (p=0.02).ConclusionOur data suggested that NSRH upholds effectiveness of conventional RH, without increasing recurrence and complication rates but improving pelvic dysfunction rates.

The comparison of surgical outcomes and learning curves of radical hysterectomy by laparoscopy and robotic system for cervical cancer: an experience of a single surgeon.

ObjectiveThe aim of this study was to compare and determine the feasibility, surgical outcomes, learning curves of robotic radical hysterectomy with lymph node dissection (RRHND) to conventional laparoscopic radical hysterectomy with lymph node dissection (LRHND) performed by a single surgeon, in patients with cervical cancer.MethodsBetween April 2009 and March 2013, 22 patients underwent LRHND and 19 patients underwent RRHND. Variables such as age, body mass index, International Federation of Gynecology and Obstetrics stage, histological results, number of dissected lymph nodes, operative time, estimated blood loss, days of hospitalization and complications were reviewed. Learning curves of operation time was obtained using cumulative sum (CUSUM) method.ResultsBoth groups showed similar patient and tumor characteristics. In surgical outcome analysis, RRHND (51.8±10.4 minutes) showed longer preparing time than LRHND (42.5±14.1 minutes). In the LRHND group, 8 patients experienced postoperative complications (5 void difficulty, 1 postoperative bleeding, 1 right basal ganglia infarction, 1 fever). On the other hand, in the RRHND group, 4 patients experienced a postoperative complication (2 bleeding, 1 peritonitis, 1 dehiscence of trocar site). Using CUSUM method, the learning curves were obtained by plotting the cumulative sequential differences between each data point and the average operation time, and showed two distinct phases in both type of operations.ConclusionRRHND would be appropriate surgical approach in patients with cervical cancer with favorable outcome of less voiding difficulty. A minimum of 13 cases of robotic radical hysterectomies are required to achieve surgical improvement in the treatment of cervical cancer.

150 - Oncologic Effectiveness and Safety of Nerve-Sparing Radical Hysterectomy in Cervical Cancer

Study Objective: Nerve-sparing radical hysterectomy (NSRH) was introduced with the aim to reduce pelvic dysfunctions related to conventional radical hysterectomy (RH). Here, we sought to assess the effectiveness and safety of NSRH in a large population of cervical cancer patients undergoing either primary surgery or neoadjuvant chemotherapy followed by surgery.

Long-Term Oncological Outcome After Conventional Radical Hysterectomy Versus 2 Nerve-Sparing Modalities for Early Stage Cervical Cancer

Nerve-sparing radical hysterectomy for early stage cervical cancer was introduced to improve quality of life after treatment. Sparing the pelvic autonomic nerves reduces bladder, bowel, and sexual dysfunction. The Leiden nerve-sparing radical hysterectomy (LNSRH) was modified to the Swift procedure, the latter being more radical regarding the sacrouterine and parametrial resection. We investigate whether nerve-sparing surgery has comparable oncological outcomes as the conventional radical hysterectomy (CRH). Concurrently, we investigate whether there is a difference regarding the oncological outcomes of the 2 nerve-sparing techniques. This is a single-center, observational prospective cohort study analyzing oncological outcomes in women undergoing CRH (1994-1999), LNSRH (2001-2005), or Swift procedure (2006-2010) for early stage cervical cancer (International Federation of Gynecology and Obstetrics IA2-IIA). Three hundred sixty-three patients (124 CRH, 122 LNSRH, and 117 Swift) were included. International Federation of Gynecology and Obstetrics stage IB2 or higher (P = 0.005) was significantly more prevalent in the CRH cohort. The 5-year pelvic relapse-free survival and overall survival were not significantly different between the 3 cohorts (P = 0.116). Regarding the nerve-sparing cohorts, the Swift cohort showed a significant better 5-year overall survival (87.2%) compared with the LNSRH cohort (78.8%) (P = 0.04). In the LNSRH cohort, resection planes less than 5 mm free and need for adjuvant therapy were significantly higher than in the Swift cohort (P = 0.026 and 0.046, respectively). The nerve-sparing radical hysterectomy shows a similar oncological outcome compared with the CRH. The more radical Swift version of nerve-sparing techniques is preferable to the former LNSRH procedure.

Favorable factors for preserving bladder function after nerve-sparing radical hysterectomy: A protocol-based validation study.

To investigate favorable factors of nerve-sparing radical hysterectomy (NSRH) for preserving the pelvic autonomic nerves and subsequent bladder function and to compare the safety between NSRH and conventional radical hysterectomy (CRH) for cervical cancer. We recruited 87 consecutive patients with IB1-IIA cervical cancer who underwent NSRH, and reviewed the information of 81 patients who received CRH for historical comparisons. One gynaecologic oncologist performed all operations. IB1 disease was the only favorable factor for unilateral or bilateral preservation (adjusted OR, 0.245; 95% CI, 0.077-0.774), whereas IB1 disease and squamous cell carcinoma (SqCC) were favorable for bilateral preservation (adjusted ORs, 0.336 and 0.116; 95% CIs, 0.162-0.982 and 0.023-0.581). The median duration of postoperative catheterization (DPC) was different among bilateral, unilateral and failed preservation (median 6 vs 18 vs 90 days; P < 0.001). The median DPC was shorter in NSRH patients with stage IB1 disease or SqCC (7 vs 14 days; P < 0.05) despite no difference between NSRH and CRH in those with IB2-IIA disease or non-SqCC. Survival was not different between NSRH and CRH patients. IB1 disease and SqCC are favorable for preserving the pelvic autonomic nerves and subsequent bladder function without compromising survival outcomes in patients treated with NSRH.

Short and long-term urodynamic and quality of life assessment after nerve sparing radical hysterectomy: a prospective pilot study

ObjectiveThe aim of this study was to compare pre- and postoperative bladder function and quality of life (QoL) in women diagnosed with gynecologic malignancy and treated with nerve sparing radical hysterectomy (NSRH). Study designBefore and after NSRH for uterine malignancy, bladder function was prospectively assessed in a small cohort of 12 women (39–72 years) suffering from uterine malignancy using urodynamic studies and a validated self-administered condition specific QoL questionnaire. Urodynamic studies were performed one day before (U0) as well as one week (U1) and 22 months (U2) after surgery. The questionnaire was applied at U0 and U2. ResultsCystometry showed detrusor contractions leading to overactive bladder incontinence in six out of nine women at short-term, which persisted in three women at long-term follow-up leading to a significant impaired QoL. Voiding function and bladder sensation remained uncompromised after surgery. ConclusionsNSRH preserves voiding function and bladder sensation. However, short and long-term urodynamic detrusor overactivity and urge incontinence was observed in a significant number of women although symptoms improved over time. These data are important for counselling women and for the design of larger studies to assess the benefits of NSRH versus conventional radical hysterectomy (RH).

Robotic Compartment-Based Radical Surgery in Early-Stage Cervical Cancer.

A radical hysterectomy with pelvic lymphadenectomy is the recommended treatment option in patients with early-stage cervical cancer. Although various classifications were developed in order to define the resection margins of this operation, no clear standardization could be achieved both in the nomenclature and in the extent of the surgery. Total mesometrial resection (TMMR) is a novel procedure which aims to remove all components of the compartment formed by Müllerian duct in which female reproductive organs develop. TMMR differs from the conventional radical hysterectomy techniques in that its surgical philosophy, terminology, and partly resection borders are different. In this paper, a TMMR with therapeutic pelvic lymphadenectomy operation that we performed for the first time with robot-assisted laparoscopic (robotic) approach in an early-stage cervical cancer patient was presented. This procedure has already been described in open surgery by Michael Höckel and translated to the robotic surgery by Rainer Kimmig. Our report is the second paper, to our knowledge, to present the initial experience regarding robotic TMMR in the English literature.

Duplication of Conventional Multiport Laparoscopic Radical Hysterectomy Steps with Other Minimal Access Modalities (LESS, OASIS, Robotic).

To duplicate the steps of conventional multiport laparoscopic radical hysterectomy by 3 other minimal access modalities: robotic radical hysterectomy, laparoendoscopic single-site surgery (LESS), and orifice-assisted small-incision surgery (OASIS). Institutional Review Board approval was obtained. Between January 2009 and December 2012, the charts of the patients who had undergone radical hysterectomy by these 4 minimal access modalities were analyzed. Galaxy Care Laparoscopy Institute, Pune, India. Fifteen patients in each arm with stage IB1 cervical cancer with a histopathological report of squamous cell carcinoma were analyzed. All patients had undergone radical hysterectomy by a conventional multiport, robotic, LESS, or OASIS technique. The type of procedure was decided by joint consultancies of doctor and patient. All patients were analyzed retrospectively for time, blood loss, oncologic clearance, and complications. The median follow-up of all patients was 12 months (range, 8-18 months). The "Pune technique" of radical hysterectomy consists of 6 steps: (1) posterior U cut; (2) dissection of pouch of Douglas; (3) pararectal space dissection; (4) anterior U cut; (5) uretric tunnel dissection; and (6) ilio-obturator lymph node dissection. The radical hysterectomy is a type B radical hysterectomy. Proper patient selection plays an important role in radical hysterectomy with different minimal access operative modalities. Parametrium clearance of 2.25 to 3.5 cm can be obtained with different modalities [1-5]. As of the writing of this report, none of the 60 patients evaluated had experienced recurrence, and all are disease-free. The study period was 4 years. To conclude, our data indicate that the steps of conventional multiport radical hysterectomy by the Pune technique can be duplicated by other minimal access modalities, including robotic radical hysterectomy, LESS, and OASIS.