Nerve-sparing radical hysterectomy: a surgical technique for preserving the autonomic hypogastric nerve.
OBJECTIVE
Recently, a nerve-sparing radical hysterectomy has been proposed for cervical cancer to reduce morbidity. The aim of this study is (i) to describe the surgical anatomy of the autonomic nervous system, (ii) to describe a new nerve-sparing technique for Piver III radical hysterectomy (RH) using the CUSA, in which greater attention was paid to the autonomic nervous pathway, and (iii) to assess the feasibility and the impact of this nerve-sparing technique on the incidence of early bladder dysfunctions.


METHODS
Twenty-three patients with cervical cancer were submitted to nerve-sparing Piver III RH with pelvic lymphadenectomy. Postoperative assessment of bladder function consisted draining the bladder for 3 days using Foley catheterization. Then, we started draining the bladder every 3 h with a no. 10 French catheter to register the onset of spontaneous voiding and to assess the postvoid residual urine volume (PVR).


RESULTS
The nerve-sparing technique were performed satisfactorily in all cases. The mean operating time was 219 min (range: 150-270). The mean blood loss was 489 ml (range: 200-800). The average period of hospitalization was 10 days (range: 5-16). Two (9%) patients were discharged with self-catheterization, and one of them recovered the ability to void her bladder spontaneously by the time of her first visit to the outpatient clinic.


CONCLUSIONS
This nerve-sparing RH technique using the CUSA proved feasible, with promising results in terms of preventing early bladder dysfunction. The average time between surgery and the onset of spontaneous voiding was acceptable. Further prospective controlled studies are needed to confirm our data.
Raspagliesi
Francesco
F
Department of Gynecologic Oncology, Istituto Nazionale Tumori, Milan 20133, Italy. dittotony@hotmail.com
Ditto
Antonino
A
Fontanelli
Rosanna
R
Solima
Eugenio
E
Hanozet
Francesco
F
Zanaboni
Flavia
F
Kusamura
Shigeki
S
D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007001:Hypogastric Plexus / Q000033:anatomy & histology / Q000601:surgery*; D007044:Hysterectomy / Q000379:methods*; D008197:Lymph Node Excision; D008875:Middle Aged; D002583:Uterine Cervical Neoplasms / Q000601:surgery*