Laparoscopic Nerve-sparing Radical Research Articles

Evaluation of surgical and functional outcomes after bilateral intrafascial nerve-sparing laparoscopic radical prostatectomy after prostate resection for incidental prostate cancer

Evaluation of surgical and functional outcomes after bilateral intrafascial nerve-sparing laparoscopic radical prostatectomy after prostate resection for incidental prostate cancer

"Functional Outcomes and Quality of Life After Laparoscopic Nerve-Sparing Radical Treatment of Parametrial Deep Infiltrating Endometriosis"

"Functional Outcomes and Quality of Life After Laparoscopic Nerve-Sparing Radical Treatment of Parametrial Deep Infiltrating Endometriosis"

Analysis of the Efficacy of LNSRH Surgery for Early Cervical Cancer Based on T, B, and NK Lymphocytes

Background: The analysis is based on the level of T, B, NK lymphocytes to evaluate the efficacy of laparoscopic nerve-sparing radical hysterectomy (LNSRH) for early cervical cancer. Methods: Selected 30 patients with early cervical cancer who underwent LNSRH surgery in Tianjin Fifth Central Hospital from December 2019 to January 2021 as the cervical cancer group, and 30 healthy female who underwent physical examination in our hospital during the same period were selected as the control group. The expressions of CD4+, CD8+, CD20+, and CD57+ were detected by flow cytometer, female sexual function index (FSFI) and overall assessment scale of cancer treatment function (FACT-G) score were used to evaluate female sexual function and quality of life, and the receiver operating characteristic curve (ROC) was used to analyze the expression predictive value of CD4+, CD8+, CD20+, and CD57+ in LNSRH of early cervical cancer. Results: The expression of CD4+ and CD57+ in the cervical cancer group was lower than that in the healthy group,and the expression of CD8+ and CD20+ was higher than that in the healthy group (p < 0.05). The expression of preoperative CD4+ and CD57+ was higher for postoperative, and the expression of preoperative CD8+ and CD20+ was lower (p < 0.05) for postoperative. The expression of postoperative 1 day CD4+ and CD57+ was higher for at 3 days postoperative, and the expression of postoperative 1 day CD8+ and CD20+ was lower at 3 days postoperative (p < 0.05). CD4+, CD57+ expression was positively correlated with FSFI score, and CD8+, and CD20+ expression was negatively correlated with FSFI score, CD4+, and CD57+ expression was positively correlated with FACT-G score, and CD8+, and CD20+ expression was negatively correlated with FACT-G score (p < 0.05). ROC analysis of CD4+, CD8+, CD20+, CD57+ expression sensitivity was lower than the four-item combination, the specificity was higher than the four-item combination and the results with significant statistical difference (p < 0.05) and the four combined tests have good predictive value for the efficacy of LNSRH for early cervical cancer (p < 0.05). Conclusions: Cervical cancer patients were mainly cellular immunity and performed low expression of CD4+, high expression of CD8+, high expression of CD20+, and low expression of CD57+. T, B, and NK lymphocytes could be used for immunological detection of cervical cancer.

Surgical Anatomy of Nerve as Seen in Nerve Sparing Radical Hysterectomy for Endometrial CA (>50% INVASION)

<h3>Study Objective</h3> surgical anatomy of nerves in nerve sparing radical hysterectomy in endometrial CA (>50% invasion). <h3>Design</h3> Prospective analysis. <h3>Setting</h3> Patient underwent 3D laparoscopy all the procedure done by experienced and qualified team/ <h3>Patients or Participants</h3> CA endometrium with >50 % invasion. <h3>Interventions</h3> Nerve sparing laparoscopy done. <h3>Measurements and Main Results</h3> in all patients reviewed at monthly interval followed by 3 monthly interval with USG (A+P) PET scan done at the end of 6 month did not reveal any recurrence. median follow-up 18 months. faster recovery of bladder function, good anorectal function, better sexual arousal and response. <h3>Conclusion</h3> By knowing the better knowledge about all pelvic nerves we can achieve a laparoscopic nerve sparing radical hysterectomy and give better life to patient. as a surgeon knowledge of predictive surgical anatomy of nerve is must.

Laparoscopic Nerve-Sparing Radical Parametrectomy for Deep Lateral Parametrial Endometriosis

<h3>Study Objective</h3> To demonstrate the anatomical and technical highlights of nerve-sparing radical parametrectomy for deep lateral parametrial endometriosis (LPE). <h3>Design</h3> Stepwise demonstration of this method with narrated video footage. <h3>Setting</h3> An urban general hospital. LPE may involves ureter, internal iliac vessels, inferior hypogastric plexus, pelvic splanchnic nerves, or sometimes sacral nerve roots. Although LPE is not overly rare, isolation of the autonomic nerves from LPE cannot always be guaranteed. In cases where endometriosis lesions are embedded in the deep parametrium, nerve-sparing techniques are no longer considered feasible, except in cases with unilateral involvement. However, even one-sided radical parametrectomy may actually lead to pelvic organ dysfunctions, which seriously affects quality of life. <h3>Patients or Participants</h3> A 38-year-old woman, para 1, presented with a five-year history of severe chronic pelvic and gluteal pain, all of which were resistant to pharmacotherapy. MRI revealed right ovarian endometrioma with LPE reaching the lateral pelvic wall. <h3>Interventions</h3> Laparoscopic surgery. <h3>Measurements and Main Results</h3> Main outcome measures were releasing from severe pain, avoidance of postoperative morbidity and preservation of fertility. The procedure was performed using 8 steps, as follows: Step 1, adhesiolysis and adnexal surgery; Step 2, complete ureterolysis; Step 3, identification and dissection of the hypogastric nerve and inferior hypogastric plexus with development of the pararectal space; Step 4, dissection of internal iliac vessels; Step 5, identification and dissection of sacral roots S2-S4 and pelvic splanchnic nerves; Step 6, complete removal of LPE; Step 7, hemostasis and assessment of tissue perfusion using ICG; and Step 8, application of barrier agents to prevent adhesion. The patient developed no perioperative complications, including postoperative bladder, rectal or sexual dysfunctions. Pain was completely resolved after surgery. <h3>Conclusion</h3> Laparoscopic nerve-sparing radical parametrectomy is technically safe and feasible for selected patients with LPE. Suitably tailored treatment should be provided for each individual, based on both the latest scientific evidence and life planning for the patient.

Postsurgical urodynamic study of total laparoscopic nerve-sparing radical hysterectomy for uterine cervical cancer.

To evaluate the impact on urodynamic results between the laparoscopic nerve-sparing radical hysterectomy (LRH) following a step-by-step procedure and abdominal nerve-sparing radical hysterectomy (ARH) for patients with uterine cervical cancer. This retrospective study enrolled 76 patients with cervical cancer: 35 in the LRH group and 41 in the ARH group. We analyzed their postoperative bladder function in a urodynamics study and examined the volume of resected pelvic nerves contained in parametrial sections using S-100 antibody staining. Estimated blood loss and hospital stay after operation for the LRH group were significantly better than those in the ARH group (p < 0.0001). As well, the number of harvested lymph nodes was significantly higher in the LRH group (p=0.044). There was no difference in perioperative complications between the two groups in this study. The 5-year disease-free survival rates and overall survival rates were 91.2% and 94.0% in the LRH group and 87.8% and 95.1% in the ARH group, both respectively. Although the median residual urine volume were no statistical differences between the LRH group and the ARH group, the recovery of postoperative bladder function (uroflowmetry) in the LRH group rapidly reached presurgery levels at 1month, and the LRH group had a smaller number of s-100 antibody stained nerves contained the parametrial sections. We demonstrated that LRH following a step-by-step procedure could achieve a higher level of prevention of damage to the bladder branch of the pelvic splanchnic nerve plexus and thus restore bladder function more rapidly.

The Effects of Hysterectomy on Urinary and Sexual Functions of Women with Cervical Cancer: A Systematic Review.

This systematic review aims at describing the prevalence of urinary and sexual symptoms among women who underwent a hysterectomy for cervical cancer. A systematic search in six electronic databases was performed, in September 2019, by two researchers. The text search was limited to the investigation of prevalence or occurrence of lower urinary tract symptoms (LUTS) and sexual dysfunctions in women who underwent a hysterectomy for cervical cancer. For search strategies, specific combinations of terms were used. A total of 8 studies, published between 2010 and 2018, were included in the sample. The average age of the participants ranged from 40 to 56 years, and the dysfunctions predominantly investigated in the articles were urinary symptoms (n = 8). The rates of urinary incontinence due to radical abdominal hysterectomy ranged from 7 to 31%. The same dysfunction related to laparoscopic radical hysterectomy varied from 25 to 35% and to laparoscopic nerve sparing radical hysterectomy varied from 25 to 47%. Nocturia ranged from 13%, before treatment, to 30%, after radical hysterectomy. The prevalence rates of dyspareunia related to laparoscopic radical hysterectomy and laparoscopic nerve sparing radical hysterectomy ranged from 5 to 16% and 7 to 19% respectively. The difficulty in having orgasm was related to laparoscopic radical hysterectomy (10 to 14%) and laparoscopic nerve sparing radical hysterectomy (9 to 19%). Urinary and sexual dysfunctions after radical hysterectomy to treat cervical cancer are frequent events. The main reported disorders were urinary incontinence and dyspareunia.

Survival Impacts of Perineural Invasion on Patients Under Different Radical Hysterectomies Due to Early Cervical Cancer.

ObjectiveCervical cancer is a common gynecological malignancy. In addition to the open radical hysterectomy (ORH) and laparoscopic radical hysterectomy (LRH), laparoscopic nerve-sparing radical hysterectomy (LNSRH) could be another treatment option since it could preserve urinary, colorectal, and sexual functions. However, LNSRH might result in early cancer metastasis and recurrence due to inadequate tumor resection. Additionally, whether LNSRH should be considered based on perineural invasion (PNI) status remains controversial. To assess different types of hysterectomy on the outcome of early cervical cancer with PIN.MethodsA retrospective study was performed in early cervical cancer patients who received ORH, LRH, or LNSRH between January 2012 and December 2019. Age, FIGO cancer stages, histopathological types, tumor size, histological grade, invasion depth, lymph node metastasis, lymphovascular space invasion, and PNI were documented. Disease-free survival (DFS) and overall survival (OS) were recorded.ResultsA total of 174 patients were included, with 33, 69, and 72 patients received LRH, ORH, and LNSRH, respectively. Twenty-one patients (12.1%) had PNI. DFS (P = 0.000) and OS (P = 0.022) periods were shortened in positive PNI patients than in negative PNI patients (P = 0.000 and 0.022, respectively). In patients with positive PNI, lymph node metastasis, but not the surgery type, was an independent risk factor for DFS and OS (P = 0.000).ConclusionEarly cervical cancer patients with PNI had shorter postoperative DFS and OS periods. In these patients, lymph node metastasis, but not the type of hysterectomy, was independently associated with DFS and OS.

Total Laparoscopic Nerve-Sparing Radical Hysterectomy Using the No-look No-touch Technique.

Radical hysterectomy is a standard operation for patients with early-stage cervical cancer. Over the recent decades, laparoscopic radical hysterectomy has been considered an alternative treatment. In 2018, the results of the laparoscopic approach to cervical cancer trial suggested that women with early-stage cervical cancer who underwent minimally invasive surgery for radical hysterectomy had poorer prognosis than those who underwent open surgery. This finding was unexpected, and direct evidence supporting poor prognosis related to minimally invasive radical hysterectomy was not available because the trial was not designed to evaluate the cause of the inferior outcomes. Tumor spillage caused by surgeon-related factors, including squeezing of the uterine cervix and tumor exposure to circulating CO 2 gas, is considered to be associated with the poor prognosis of patients who underwent minimally invasive radical hysterectomy. We believe that protective maneuver to avoid tumor spillage is the key to improve oncologic outcomes of cervical cancer. Here, we present a procedure of total laparoscopic nerve-sparing radical hysterectomy for early-stage cervical cancer in which techniques, such as the “no-look no-touch technique,” were used to prevent tumor spillage.

Prospective evaluation of urinary continence after laparoscopic radical prostatectomy using a validated questionnaire and daily pad use assessment: which definition is more relevant to the patient's perception of recovery?

IntroductionNo standard definition for urinary continence after radical prostatectomy exists, and there are discrepancies in continence rates reported in the literature, as well as rates reported by physicians and patients. Therefore, we used two tools, a validated questionnaire and daily pad use, to identify the criteria that best reflects patients’ perceptions of continence recovery.Material and methodsThis is a prospective study of 74 patients who underwent nerve-sparing laparoscopic radical prostatectomy. Continence was assessed monthly for 3 months following catheter removal using the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI SF) and by recording the number of pads the patients used on a daily basis. According to daily pad use, patients were categorized as either dry (no-pads), socially continent (0–1 pad) or incontinent (≥2 pads).ResultsSeventy-four patients were enrolled with a mean age of 64.3 (±5.6) years. There were no significant differences in continence rates using scores from the International Consultation on Incontinence Questionnaire- Short Form (ICIQ-UI SF) or no-pad use (29.7% vs 32.4%, 45.9% vs 48.6% and 54.1% vs. 54.1%, at the 1-, 2- and 3-month follow-ups, respectively). However, the number of socially continent patients was significantly higher (59.5%, 70.3% and 81.1%, at the 1-, 2- and 3-month follow-ups, respectively [p <0.001]).ConclusionsThe totally dry definition better reflected patients’ perceptions rather than the socially continent definition for the evaluation of continence recovery following laparoscopic radical prostatectomy. To avoid discrepancies, we recommend the use of a validated questionnaire as well as the no-pad definition to standardize the reporting of post radical prostatectomy continence rates.

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.

Laparoscopic nerve-sparing radical hysterectomy without uterine manipulator for cervical cancer stage IB: description of the technique, our experience and results after the era of LACC trial.

The aim of this study is to evaluate surgical data and oncological outcome of laparoscopic nerve-sparing radical hysterectomy without uterine manipulator for cervical cancer stage IB, over the last 8years. This retrospective study includes 32 patients with cervical cancer Figo stage (2009) IB who underwent laparoscopic nerve-sparing radical hysterectomy without using any kind of uterine manipulator. Patients were eligible if they had squamous cell carcinoma, adenocarcinoma, or adeno-squamous carcinoma, and no para-aortic lymph node involvement by imaging or after frozen section. The median value and range were assessed for operative outcomes and relapse rate and disease-free survival rate were evaluated using the Kaplan-Meier method. In the study, 32 patients were included and among them 27 women were stage IB1 (18 cases with tumor size 2-4cm) and 5 women stage IB2 (Figo stage 2009). The median age of patients was 50.5years (range 31-68) and median body mass index (B.M.I) was 25.3kg/m2 (range 19-33.5kg/m2). The average operating time was 228min (range 147-310min) and median hospital stay was 2.7days (range 2-7days). Approximate blood loss was 188ml (range 120-300ml). After a median follow-up of 37months, we had 2 recurrences out of 32 cases and no death. Especially for patients with Figo stage (2009) IB1, the recurrence rate was 3.7% (1/27). The 3-year PFS was 93.7% and the number at risk 23 (71.8%) and especially for the IB1 stage (2009) women, the 3-year PFS was 96.1% and the number at risk 21 (77.7%). The 3-year OS was 100% with no. at risk 71.8%. Laparoscopic nerve-sparing radical hysterectomy without uterine manipulator is feasible and safe surgical procedure for cervical cancer with acceptable surgical and oncological outcomes in the hands of well-trained and experienced laparoscopic surgeons. Our retrospective study reveals better oncological outcome compared to other studies on the minimally invasive approach, where uterine manipulator was routinely used and no vaginal sealing of the tumor was made.

Successful Birth in a Case of Cervical Cancer Following Total Laparoscopic Nerve Sparing Radical Trachelectomy with Sentinel Node Dissection and Preventive Cerclage

Successful Birth in a Case of Cervical Cancer Following Total Laparoscopic Nerve Sparing Radical Trachelectomy with Sentinel Node Dissection and Preventive Cerclage

1499 The Urodynamics and Survival Outcomes of Different Methods of Dissecting the Inferior Hypogastric Plexus in Laparoscopicnerve-Sparing Radical Hysterectomy Of Type C: A Randomized Controlled Study

Study Objective To evaluate the effects of Water-jet in Laparoscopic Nerve Sparing Radical Hysterectomy for the patients with cervical cancer in early stage. Design This is a randomized controlled trial to compare the urodynamic and survival outcomes of different methods dissecting the inferior hypogastric plexus (IHP) during laparoscopic NSRH Setting Laparoscopic C1 RH were performed in lithotomy position under general anesthesia. Patients or Participants From 9 May 2013 to 27 October 2015, 160 Eligible patients with cervical cancer in stage IB were randomized at a ratio of 1:1 to waterjet (study group) or traditional blunt (control group) dissection of the IHP for laparoscopic type C radical hysterectomy. Interventions All patients received laparoscopic C1 radical hysterectomy performed by one surgeon. Water-jet(ERBE) was applied to perform the precise separation of IHP in study group, but the traditional method were used in control one. Measurements and Main Results All participants were subjected to urodynamic evaluations before and after NSRH. The primary measurement was the proportion of patients with residual urine (RU) B 100 ml, while secondary measurements included urodynamic parameters, disease-free survival (DFS), and overall survival (OS). At 14 days after NSRH, the study group had more patients with RU B 100 ml than the control group (82.5% vs. 62.5%, p = 0.005). The study group had similar urodynamic outcomes of preoperative and postoperative tests. Comparison with the study group and preoperative tests revealed the control group had significant bladder function impairment at 4 months after NSRH. After a median follow-up of 33 months, the dissection methods had no significant impact on DFS or OS. Conclusion Waterjet dissection of the IHP in laparoscopic NSRH resulted in a more rapid return of normal urodynamics without compromising survival outcome.ClinicalTrials.gov Identifiers NCT03015376 (PUMCHOBGYN-2013), NCT03291236 (SOCM-1).

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

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.

Clinical Anatomy Required in Identifying Pelvic Autonomic Nerve System

Video Objective Comprehension of structure of pelvic autonomic nerve system is mandatory for constant preservation of voiding function while maintaining oncological outcome of radical hysterectomy. Setting 47 years old, cervical cancer T1bN0M0. Total laparoscopic nerve sparing radical hysterectomy is presented. Interventions Superior hypogastric nerve plexus and inferior hypogastric nerves are in the same layer between pararectal space of Latzko and Okabayashi. Two subperitoneal fasciae are identified in pelvic retroperitoneal space: pre-hypogastric nerve fascia in ventral side, ureterohypogastric fascia in dorsal side of ureter and hypogastric nerves. Pelvic splanchnic nerves are identified in lateral side of pre-hypogastric nerve fascia, so preservation of these fasciae during operation result in protection of hypogastric and pelvic splanchnic nerves. Pelvic nerve plexus is identified in dorsal side of deep uterine vein and superior vesical vein. Careful slice up of these veins and preserve underlying fasciae result in protection of pelvic nerve plexus. Vesical nerve branch is identified in caudal side of posterior leaf of vesicouterine ligament (VUL). Division of posterior leaf of VUL is required to visualize vesical nerve branch, but constant preservation of voiding function is feasible once location of vesical nerve branch is understood. Outline of surgical procedure to identify and preserve hypogastric nerves and vesical nerve branch is presented in the video of TLRH for cervical cancer stage 1B1. Conclusion Once visualization of pelvic autonomic nerve system is experienced, stable preservation of voiding function in radical hysterectomy is realized.

Identification and injury to the inferior hypogastric plexus in nerve-sparing radical hysterectomy

Waterjet dissection of the inferior hypogastric plexus (IHP) resulted in a more rapid return of normal urodynamics than blunt dissection (control group) in patients who received laparoscopic nerve-sparing radical hysterectomy (NSRH) in a randomized controlled study. However, the definite reasons for these results were unknown. This subgroup analysis compared the neural areas and impairment in the IHP uterine branches harvested during NSRH as an alternative to the IHP vesical branches between the waterjet and control groups. This study included samples from 30 eligible patients in each group of the trial NCT03020238. At least one specimen from each side of the IHP uterine branches was resected. The tissues were scanned, images were captured, and the neural component areas were calculated using the image segmentation method. Immunohistochemical staining was used to evaluate neural impairment. The control and waterjet groups had similar areas of whole tissues sent for evaluation. However, the control group had significantly fewer areas (median 272158 versus 200439 μm2, p = 0.044) and a lower percentage (median 4.9% versus 3.0%, p = 0.011) of neural tissues. No significant changes in immunohistochemical staining were found between the two groups. For patients with residual urine ≤100 and >100 ml at 14 days after NSRH (42 and 18 patients, respectively), there were significantly different percentages of neural tissues in the resected samples (p < 0.001). Hence, Due to the accurate identification of IHP during NSRH, the waterjet dissection technique achieved better urodynamic results.

Feasibility of early postoperative bladder catheter removal without prior bladder-training exercises after laparoscopic nerve sparing radical hysterectomy

The aim of the study is to evaluate the feasibility of early postoperative bladder catheter removal without prior bladder-training exercises after laparoscopic nerve sparing radical hysterectomy (LNSRH). The post-operative bladder catheterisation period of 30 patients who underwent LNSRH at two institutes in Egypt and Italy were prospectively evaluated with postoperative drainage of the bladder through a Foley catheter for two days without performing bladder-training exercise. The median duration for postoperative bladder catheterisation was 3.5 (3–5) days. Within the fifth postoperative day, 82.7% had a PVR urine volume less than 100 ml. None of the patients had PVR urine more than 100 ml more than 10 days after the operation with no need for self-catheterisation. These results support early postoperative bladder catheter removal without prior bladder-training exercises following LNSRH.IMPACT STATEMENTWhat is already known on this subject? Bladder-training exercise was used routinely following radical hysterectomy (RH) operations before bladder catheter removal. Only two studies reported that these exercises could be omitted, but one study was done on both laparoscopic and open RH patients and the other did not show whether the operation was nerve-sparing and whether it was done by laparoscopy or open technique.What the results of this study add? This study’s results support early postoperative bladder catheter removal without prior bladder-training exercises after laparoscopic nerve sparing RH.What the implications are of these findings for clinical practice and/or further research? Excluding the unnecessary procedure of bladder training, which is time- and effort-consuming, after the operation.

The Urodynamics and Survival Outcomes of Different Methods of Dissecting the Inferior Hypogastric Plexus in Laparoscopic Nerve-Sparing Radical Hysterectomy of Type C: A Randomized Controlled Study.

Little data exist about the impact of dissection methods on bladder function during nerve-sparing radical hysterectomy (NSRH). This randomized controlled trial compared the urodynamic and survival outcomes of different methods dissecting the inferior hypogastric plexus (IHP) during laparoscopic NSRH. Eligible patients presenting with stage IB cervical cancer from 9 May 2013 to 27 October 2015 were randomized at a ratio of 1:1 and subjected to waterjet (study group) or traditional blunt (control group) dissection of the IHP for laparoscopic type C radical hysterectomy. Participants were subjected to urodynamic evaluations before and after NSRH. The primary measurement was the proportion of patients with residual urine (RU) ≤ 100ml, while secondary measurements included urodynamic parameters, disease-free survival (DFS), and overall survival (OS). In total, 191 women met the inclusion criteria, and 160 patients were included in the final analysis, with 80 randomized to each group. At 14days after NSRH, the study group had more patients with RU ≤ 100ml than the control group (82.5% vs. 62.5%, p = 0.005). The study group had similar urodynamic outcomes of preoperative and postoperative tests. Comparison with the study group and preoperative tests revealed the control group had significant bladder function impairment at 4months after NSRH. After a median follow-up of 33months, the dissection methods had no significant impact on DFS or OS. Waterjet dissection of the IHP in laparoscopic NSRH resulted in a more rapid return of normal urodynamics without compromising survival outcome. ClinicalTrials.gov Identifiers NCT03015376 (PUMCH-OBGYN-2013), NCT03291236 (SOCM-1).

Minimally invasive surgery improves short-term outcomes of nerve-sparing radical hysterectomy in patients with cervical cancer: a propensity-matched analysis with open abdominal surgery.

ObjectivesNerve-sparing radical hysterectomy has been implemented in order to reduce pelvic floor dysfunctions in women undergoing radical surgery for cervical cancer. Here, we aimed to investigate if the adoption of laparoscopic surgery impacts on patients' outcomes.MethodsData of consecutive patients affected by cervical cancer who had laparoscopic nerve-sparing radical hysterectomy were matched 1:1 with an historical cohort of patients undergoing open procedure. A propensity-score matched algorithm was applied.ResultsThirty-five patients' pairs (70 patients: 35 undergoing laparoscopic vs. 35 undergoing open abdominal nerve-sparing radical hysterectomy) were included. Demographic and baseline oncologic characteristics were balanced between groups. Patients undergoing laparoscopic surgery had similar operative time than patients undergoing open abdominal procedures (249 [±91.5] vs. 223 [±65.0] minutes; p=0.066). Laparoscopic approach correlated with lower blood loss (30.5 [±11.0] vs. 190 [90.4] mL; p<0.001) and shorter hospital stay (3.2 [±1.2] vs. 5.4 [2.0] days; p=0.023). Patients undergoing laparoscopy experienced a lower 30-day pelvic floor dysfunction rate than patients having open surgery. Moreover, they experienced shorter recovery of bladder function than patients having open procedures (median, 7 vs. 9 days; p=0.004, log-rank test).ConclusionLaparoscopic approach resulted in a faster recovery of bladder function in comparison to open surgery for patients undergoing nerve-sparing radical hysterectomy.