Nerve-sparing Radical Hysterectomy Research Articles

Nerve-sparing radical hysterectomy compared to standard radical hysterectomy for women with early stage cervical cancer (stage Ia2 to IIa).

Radical hysterectomy is one of the standard treatments for stage Ia2 to IIa cervical cancer. Bladder dysfunction caused by disruption of the pelvic autonomic nerves is a common complication following standard radical hysterectomy and can affect quality of life significantly. Nerve-sparing radical hysterectomy is a modified radical hysterectomy, developed to permit resection of oncologically relevant tissues surrounding the cervical lesion, while preserving the pelvic autonomic nerves. To evaluate the benefits and harms of nerve-sparing radical hysterectomy in women with stage Ia2 to IIa cervical cancer. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE via Ovid (1946 to May week 2, 2018), and Embase via Ovid (1980 to 2018, week 21). We also checked registers of clinical trials, grey literature, reports of conferences, citation lists of included studies, and key textbooks for potentially relevant studies. We included randomised controlled trials (RCTs) evaluating the efficacy and safety of nerve-sparing radical hysterectomy compared to standard radical hysterectomy for women with early stage cervical cancer (stage Ia2 to IIa). We applied standard Cochrane methodology for data collection and analysis. Two review authors independently selected potentially relevant RCTs, extracted data, evaluated risk of bias of the included studies, compared results and resolved disagreements by discussion or consultation with a third review author, and assessed the certainty of evidence. We identified 1332 records as a result of the search (excluding duplicates). Of the 26 studies that potentially met the review criteria, we included four studies involving 205 women; most of the trials had unclear risks of bias. We identified one ongoing trial.The analysis of overall survival was not feasible, as there were no deaths reported among women allocated to standard radical hysterectomy. However, there were two deaths in among women allocated to the nerve-sparing technique. None of the included studies reported rates of intermittent self-catheterisation over one month following surgery. We could not analyse the relative effect of the two surgical techniques on quality of life due to inconsistent data reported. Nerve-sparing radical hysterectomy reduced postoperative bladder dysfunctions in terms of a shorter time to postvoid residual volume of urine ≤ 50 mL (mean difference (MD) -13.21 days; 95% confidence interval (CI) -24.02 to -2.41; 111 women; 2 studies; low-certainty evidence) and lower volume of postvoid residual urine measured one month following operation (MD -9.59 days; 95% CI -16.28 to -2.90; 58 women; 2 study; low-certainty evidence). There were no clear differences in terms of perioperative complications (RR 0.55; 95% CI 0.24 to 1.26; 180 women; 3 studies; low-certainty evidence) and disease-free survival (HR 0.63; 95% CI 0.00 to 106.95; 86 women; one study; very low-certainty evidence) between the comparison groups. Nerve-sparing radical hysterectomy may lessen the risk of postoperative bladder dysfunction compared to the standard technique, but the certainty of this evidence is low. The very low-certainty evidence for disease-free survival and lack of information for overall survival indicate that the oncological safety of nerve-sparing radical hysterectomy for women with early stage cervical cancer remains unclear. Further large, high-quality RCTs are required to determine, if clinically meaningful differences of survival exist between these two surgical treatments.

The anatomical structure of the paravesico-vaginal space, a novel landmark for nerve-sparing radical hysterectomy.

In addition to the para-vesical space, the para-rectal space, and the Okabayashi space, previous anatomic studies have proposed a fourth space,[1][1] the para-vaginal space,[2][2] when performing nerve-sparing radical hysterectomy. We recently introduced an improved nerve-sparing radical

Profile of treatment-related complications in women with clinical stage IB-IIB cervical cancer: A nationwide cohort study in Japan.

ObjectiveTo examine clinico-pathological factors associated with surgical complications and postoperative therapy for clinical stage IB-IIB cervical cancer.MethodsThis nationwide multicenter retrospective study examined women with clinical stage IB-IIB cervical cancer who underwent radical hysterectomy plus pelvic and/or para-aortic lymphadenectomy between 2008–2009 at 87 institutions of the Japanese Gynecologic Oncology Group (n = 693). Multivariate models were used to identify independent predictors of perioperative grade 3–4 complications and bladder dysfunction.ResultsThe overall intraoperative and postoperative complication rates were 3.3% and 9.8%, respectively. Clinical stage was not associated with perioperative complications (P = 0.15). Radiotherapy-based adjuvant therapy was significantly associated with an increased risk of postoperative complications (radiotherapy alone: adjusted-odds ratio [OR] 3.19, 95% confidence interval [CI] 1.46–6.99, P = 0.004; radiotherapy plus chemotherapy: adjusted-OR 3.26, 95%CI 1.66–6.41, P = 0.001), whereas chemotherapy was not (P = 0.45). Nerve-sparing surgery significantly reduced the risk of postoperative bladder dysfunction (adjusted-OR 0.57, 95%CI 0.37–0.90, P = 0.02) whereas adjuvant chemotherapy increased the risk of bladder dysfunction (adjusted-OR 2.06, 95%CI 1.16–3.67, P = 0.01). Among women receiving adjuvant chemotherapy, nerve-sparing radical hysterectomy significantly reduced the risk of bladder dysfunction (15.0% versus 32.9%, OR 0.31, 95%CI 0.14–0.68, P = 0.004). After propensity score matching, survival outcomes were similar with both types of adjuvant therapy (radiotherapy-based versus chemotherapy, P>0.05).ConclusionOur study highlighted two distinct complication profiles of adjuvant therapy after radical hysterectomy for clinical stage IB-IIB cervical cancer, with radiotherapy increasing grade 3–4 adverse events and chemotherapy increasing bladder dysfunction. In this setting, nerve-sparing surgery may be useful if chemotherapy is being considered for adjuvant therapy.

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.

Robotic-Assisted Laparoscopic Nerve Sparing Radical Hysterectomy Improves Long-Term Bladder Function: Based on Urodynamic Assessment

Robotic-Assisted Laparoscopic Nerve Sparing Radical Hysterectomy Improves Long-Term Bladder Function: Based on Urodynamic Assessment

Limited Energy Dissection of the Parametrium during Modified Laparoscopic Nerve-Sparing Radical Hysterectomy

Objective: The aim of this study was to investigate the feasibility and safety of limited energy parametrial resection/dissection (LEPRD) in laparoscopic nerve plane-sparing radical hysterectomy (NPSRH) and to evaluate its effectiveness in pelvic autonomic nerve preservation compared to bipolar energy dissection.

Effect of Laparoscopic Nerve-Sparing Radical Hysterectomy on Bladder Function Recovery

Background: Radical hysterectomy could result in dysfunctions of pelvic organs and a decline in quality of life. Method: 298 patients who had underwent laparoscopic radical hysterectomy were retrospectively analyzed in this study, of which 216 patients had underwent laparoscopic nerve-sparing radical hysterectomy (LNSRH) and 82 had underwent classical laparoscopic radical hysterectomy (LRH). The mean duration of the postoperative catheterization, a questionnaire and an urodynamic examination were used to assess the bladder functions. Results: The mean duration of the postoperative catheterization in the LNSRH group was shorter than that in the LRH group (13 days versus 18 days, p < 0.01). The incidences of tension urinary incontinence, postoperative voiding time and dysuria symptoms in the LNSRH group, but not in the LRH group, had recovered to preoperative levels in the following 6 months. The frequency of nocturnal urination had recovered to preoperative level at 12 months post-operation in the LNSRH group. The maximum flow rate (MFR), average flow rate (AFR), first voiding sense (FVS), maximum voiding sense (MVS) and maximum detrusor pressure (MDP) in the LNSRH group were better than those in the LRH group (p < 0.05), and patients in the LRH group suffered much more frequently from tension urinary incontinence, prolonged urination time, dysuria and urinary endless compared with those in the LNSRH group (p < 0.05). Conclusion: LNSRH can effectively retain the bladder function, but we should pay attention to the invasion of peripheral nerves.

713 - Total Laparoscopic Nerve Sparing Radical Hysterectomy with Vaginal Stump Closure

Objective: Laparoscopic surgery is reported to have higher incidence of tumor dissemination in abdominal cavity than laparotomy. Procedure of type III nerve sparing radical hysterectomy is shown in this video. Whether vaginal stump closure before complete resection of uterus could be a solution of this problem or not is examined.

709 - Laparoscopic Nerve-Sparing Radical Hysterectomy for Cervical Cancer Using Karl Storz IMAGE1 S Comparing with Striker 1088 HD

Objective: Given the difficulties during such high complexity surgery, image quality is a main concern for the correct anatomical landmarks analysis, a new technology must be considered. The main objective is to demonstrate the new technology of Karl Storz IMAGE1 S camera, comparing it to the Striker 1088 HD during a Nerve-Sparing Radical Hysterectomy for Cervical Cancer.

FEASIBILITY AND FUNCTIONAL OUTCOME OF LAPAROSCOPIC NERVE SPARING RADICAL HYSTERECTOMY.

ABSTRACT Aim: Evaluation of the feasibility of laparoscopic nerve sparing radical hysterectomy in comparison to the non-nerve sparing type. Methodology:Patient recruitment started from November 2014 to November 2016, patients who underwent laparoscopic type C1 hysterectomy and laparoscopic type C2 hysterectomy according to Querleu-Morrow classification(1) at our departments were prospectively evaluated. The inclusion criteria included: Patients with cervical carcinoma Stage IA2 to stage IIB cervical cancer according to FIGO staging and Stage II-III endometrial cancer with cervical involvement according to FIGO staging. Postoperative drainage of the bladder through a Foley catheter was maintained for 2 days and removed on the third day and the patients were asked to perform spontaneous voiding every 3 hours followed immediately by drainage of the bladder by urinary catheter to assess the post void residual (PVR) urine volume. The procedure was repeated until the PVR is less than 100 ml. The voiding function was considered normal when the patient had 2 consecutive measurements of PVR urine less than 100 ml and abnormal if the patient had a PVR urine more than 100 ml with need of self- catheterization after 4 weeks from the date of surgery. Results:46 patients were included in the study, 30 patients underwent type C1 LNSRH (Group A) and 16 patients underwent type C2 LRH (Group B). The mean age was 49.1±13.1 and 51.2±11.8, median BMI was 26.2(22.9-28.5) and 23.8(21-26.6) respectively for the 2 groups. The mean operative time was 240.1±65.5 in group A and 308.1±83 in group B (P value=0.004). The rate of intraoperative complications was 10% in group A and 12.5% in group B. The median duration of postoperative catheterization until the PVR urine volume was less than 100 ml was 3.5(3-5) days in group A and 6(4-8.5) days in group B (P value=0.002), The rate of late postoperative complications including bladder dysfunction was 3.3% (Group A) and 31.25% (Group B) (P value 0.002). Conclusion:Our study results supported the feasibility of LNSRH technique with better functional outcome without compromising the oncologic safety of the procedure

Surgical and oncological outcomes of an improved nerve-sparing radical hysterectomy technique: 6 years of experience at two centres

ObjectiveAn improved nerve-sparing radical hysterectomy (NSRH), which is based on the paravesico-vaginal space, has been recently introduced in a phase II, prospective clinical trial by our team. This study aims to report the surgical and oncological outcomes of this improved NSRH. MethodsOne hundred seventy-seven consecutive patients were enrolled in our study and underwent the improved NSRH. The proportion of successful catheter removal and postvoid residual urine volume (PVR) of 50 mL or less at postoperative day 7 or day 4 was used to assess surgical outcomes. The local control rate (LCR), disease free survival (DFS), and overall survival (OS) were used to assess oncological outcomes. ResultsPostoperative 30-day complications occurred in 27/177 (15.3%) patients. The rate of successful catheter removal and PVR of 50 mL or less were 85.2% (23/27) and 66.7% (18/27) at postoperative day 7, and 73.3% (110/150) and 35.3% (53/150) at postoperative day 4. A total of 13 (7.9%) patients showed recurrence after a median follow-up time of 39.2 months (range 3.2–68.1 months). The estimated 2-year and 5-year DFS rates were 92.2% and 91.1%, respectively. Seven (4.2%) patients presented local recurrence, and five (3.0%) patients were dead at the end of the follow-up period. The estimated 5-year LCR and OS were 95.1% and 96.2%, respectively. In univariate analysis, International Federation of Gynecology and Obstetrics (FIGO) stage, lymphovascular space invasion (LVSI), and lymph node metastasis were found to be the prognostic risk factors of DFS. Patients with LVSI were associated with a worse DFS according to the multivariate analysis. ConclusionsThe improved NSRH in our study may provide better surgical outcomes without compromising the survival in patients with early cervical cancer.

The 3D reconstructions of female pelvic autonomic nerves and their related organs based on MRI: a first step towards neuronavigation during nerve-sparing radical hysterectomy.

To present in vivo female pelvic autonomous innervation and the relationship between nerves and their related organs by three-dimensional (3D) reconstruction based on magnetic resonance imaging (MRI). Thirty patients with cervical cancer who underwent pelvic MRI and agreed to undergo additional magnetic resonance neurography (MRN) sequences were enrolled in the present study. MRI images from the same patient were acquired using T2-weighted fat saturation (T2W FS) and 3D-STIR-SPACE sequences. Detailed two-dimensional (2D) segmentation and 3D reconstruction of pelvic autonomic nerves (PAN) were performed on the basis of the images of the two sequences using 3D reconstruction software. The 2D segmentation and 3D reconstruction of pelvic organs were based on T2W FS images. The consistency of the 3D models of pelvic autonomous innervation constructed from the two sequences were analysed and compared, the pelvic autonomous innervation was presented, and the relationship between nerves and their related organs was characterised. The 3D reconstructions of PAN were successfully obtained from 3D-STIR-SPACE and T2W FS sequences in 30 patients and showed high correspondence. T2W FS images also enabled 3D reconstructions of pelvic organs to visualise the 3D distribution of PAN and the positional relationships between nerves and their related organs. The pelvic autonomic nerves and their related organs can be reconstructed on the basis of MRI to present personalised 3D anatomical information and offer individualised guidance during nerve-sparing radical hysterectomy (NSRH). • Nerve-sparing radical hysterectomy is a developing trend in cervical cancer surgery • MRI allows reconstructions of pelvic autonomic nerves and their related organs • The 3D reconstructions provide detailed 3D anatomical information on nerves.

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.

Predicting factors for resumption of spontaneous voiding following nerve-sparing radical hysterectomy.

ObjectiveTo determine factors affecting voiding recovery on the day of Foley catheter removal (postoperative day 7, POD7) after nerve-sparing radical hysterectomy (NSRH) for early-stage cervical cancer.MethodsEarly-stage cervical cancer patients, who underwent type C1 radical hysterectomy between January 2006 and June 2016 were included. Clinical and pathological data were reviewed. Association between inability to attain adequate voiding function on POD7 and potential predicting factors were evaluated in univariate and multivariate analysis.ResultsOf 755 patients, 383 (50.7%) resumed adequate voiding function on POD7 while 372 (49.3%) did not. Tumor size was larger in patients whose voiding function was inadequate (2.5 vs. 2.0 cm, p=0.001). Lengths of resected parametria and adjacent vagina were more extensive in patients with inadequate voiding function (p<0.001). In univariate analysis, factors significantly associated with inability to attain adequate voiding function included tumor size >4 cm (p<0.001), primary surgeon (p<0.001), postoperative urinary tract infection (p<0.01), grossly visible tumor (p<0.01), and not having prior conization (p<0.01). In multivariate analysis, tumor size >4 cm, postoperative urinary tract infection, and primary surgeon were significantly associated with inability to attain adequate voiding function on POD7.ConclusionExtent of disease represented by tumor size, urinary tract infection as well as individual surgeon's technique independently predict resumption of adequate voiding function on POD7 following NSRH.

Limited energy parametrial resection/dissection during modified laparoscopic nerve-sparing radical hysterectomy.

ObjectiveThe aim of this study was to investigate the feasibility of using ultrasonic scalpel combined with vascular clip in parametrial management, called limited energy parametrial resection/dissection (LEPRD), in laparoscopic nerve plane-sparing radical hysterectomy (NPSRH), a modified nerve-sparing radical hysterectomy (NSRH); and to evaluate its effectiveness in pelvic autonomic nerve preservation.MethodsFrom July 2012 to January 2016, 257 consecutive patients with stage IB1 to IIA2 cervical cancer who underwent NPSRH were included in this study. Patients were divided into three cohorts according to the different parametrial resection modality. The clinical, pathological and surgery-related parameters were compared between the three groups. Short- and long-term postoperative bladder functions were evaluated.ResultsLEPRD was attempted in 94 patients, and was successful in 65 (69.1%) patients (LEPRD group). The remaining 29 (30.9%) patients required bipolar coagulation after failure of vascular clipping (combined modality group). Routine bipolar cautery was used in the other 163 patients during the parametrial resection (bipolar group). The blood loss in the LEPRD group was significantly lower than those in the other two groups (P<0.001). The rate of successful Foley removal on postoperative day 7 was significantly higher in the LEPRD group than in the bipolar group (P=0.022). The incidence of chronic voiding dysfunction was significantly lower in the LEPRD group than in the bipolar group (P=0.019).ConclusionsIt is feasible to perform LEPRD in NPSRH for cervical cancers. This kind of limited energy surgical technique is associated with less blood loss, and leads to improved postoperative bladder function.

Proteomic Analysis of Pelvic Autonomic Nerve in Nerve-sparing Radical Hysterectomy for Cervical Carcinoma.

This study was designed to identify candidate proteins which can be used for visualization of pelvic autonomic nerve during nerve-sparing surgery. Both soft tissue and vesical branch of the inferior hypogastric nerve from five women were collected during surgery. These 10 tissue specimens were analysed using liquid chromatography-mass spectrometry (LC-MS) and Human Protein Atlas (HPA) for protein expression. The existence of nerve fibres was confirmed using haematoxylin and eosin (H&E) and anti-S-100 staining. A total of 413 proteins were detected. There were three proteins (isoform 1 of fibronectin, protein S100-A8 and A9) which implied a relation with pelvic autonomic nerve. In nerve tissue from one case, the existence of nerve fibre was not confirmed. Further large studies are expected to present more nerve-specific candidate proteins which can be used for the easy and safe identification of autonomic nerves.

The morbidity of sexual dysfunction of 125 Chinese women following different types of radical hysterectomy for gynaecological malignancies

Due to early detection and effective treatment, quality of sexual life of patients with gynaecological malignancies has become an important issue. However, the morbidity of sexual dysfunction and the proportion of different kinds of sexual dysfunction after radical hysterectomy are unclear. The aim of the current study was to assess the morbidity of sexual dysfunction and to conduct multivariate logistic regression analysis of patients' sexual dysfunction. Between July 2007 and December 2012, 125 women underwent radical hysterectomy, modified radical hysterectomy, and nerve-sparing radical hysterectomy were administered a self-reported sexual function questionnaire. The preoperative, and 1- and 2-year postoperative sexual dysfunction rates were 50.5% (50/99), 86.9% (93/107), and 92.3% (72/78), respectively. The incidence rates of sexual desire disorders before operation, at postoperative year 1, and at postoperative year 2 were 14.7% (14/95), 42.1% (45/107), and 51.9% (40/77), respectively. The preoperative incidence rates of sexual arousal disorders, orgasmic disorders, and sexual pain disorders were 18.4% (18/98), 51.1% (48/94), and 10.9% (11/101), respectively. At postoperative years 1 and 2, these were 38.8% (31/80), 81.0% (64/79), and 24.4% (20/82), and 49.1% (26/53), 84.6% (44/52), and 30.2% (16/53), respectively. Multivariable regression analysis revealed that age, preserved ovary, preserved posterior vaginal wall length, preoperative stage, radiotherapy, and education background were risk factors associated with sexual dysfunction. The patients following radical hysterectomy had a high incidence of sexual dysfunction, which plateaued in postoperative years1 and 2.

Uterus transplantation: robotic surgeon perspective

To study the safety and feasibility of robotic dissection of deep pelvic vessels as applied to the robotic harvesting of a uterus from live transplant donor. Surgical video. Gynecologic oncology practice of a tertiary community cancer center. Two patients undergoing robotic nerve-sparing radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stage Ib1 cervical cancer. Application of robotic platform to precise dissection of internal iliac artery and vein, their branches, including the superficial and deep uterine artery and vein. The robotic technique for deep pelvic dissection in gynecologic oncology demonstrated here provides superior outcomes compared with the open technique. In our settings, a typical robotic nerve-sparing radical hysterectomy takes 3hours from completion of the pelvic lymphadenectomy to the moment when the patient leaves the operating room. Safety and adequacy of robotic dissection of deep pelvic vessels. The procedure's modification to the current technique demonstrated improved transplant blood supply and outflow. Demonstration of modification to current technique, that has potential to improve transplant blood supply and outflow. Using the robotic technique for nerve-sparing radical hysterectomy, the pelvic vessels can be dissected with superior precision, hemostasis, efficiency, and clinical outcomes. Due to its difficulty, nerve-sparing radical hysterectomy is not even performed via a laparotomy approach in the United States. Robotic dissection allows for better exposure of the pelvic vessels, which may allow for harvesting intact uterine vessels with internal iliac artery and vein patches, thus facilitating wider vascular anastomosis and superior blood supply and outflow of the transplant. Uterine harvesting from a live donor is currently being performed via a laparotomy technique, resulting in long procedures associated with significant morbidity. Based on our gynecologic oncology experience, a robotic approach to deep pelvic dissection is superior to laparotomy. Robotic nerve-sparing radical hysterectomy is a difficult procedure that requires knowledge of deep pelvic vessels' anatomy, precise dissection techniques, and repetition. Robotic harvesting of the uterus for transplantation from a live donor may provide better results in terms of transplant survival and donor outcomes. This type of procedure should be attempted by a robotic team that has experience in working with deep and large pelvic vessels.

Nerve-sparing radical hysterectomy compared to standard radical hysterectomy for women with early stage cervical cancer (stage Ia2 to IIa)

Nerve-sparing radical hysterectomy compared to standard radical hysterectomy for women with early stage cervical cancer (stage Ia2 to IIa)

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.