Individualized radical hysterectomy procedure using intraoperative electrical stimulation for patients with cervical cancer.
OBJECTIVE
In this study, by monitoring the varied distributions of nerve fascicles using intraoperative electrical stimulation (IES), we sought to establish an individualized operation based on the patient's unique nerve distribution pattern, and to determine whether this technique would result in a higher preservation rate.


METHODS
Radical hysterectomy was performed from 2002 to 2010. Patients in group A are the 48 cases from 2002 to 2007 in which nerve-sparing radical hysterectomy using IES as our previous report was performed. Patients in group B are the 38 cases from 2008 to 2010 in which we used our new method, which was individualized to each patient. Urodynamic study (UDS) was used to confirm nerve preservation. Nerve preservation was defined as confirming distinct detrusor contraction during urinary voiding.


RESULTS
In group B, nerve preservation rate was higher than in group A (75% vs 9 0%, P = 0.067). We classified the case-by-case nerve anatomy as whether the nerve fascicle was mainly on the medial side or on the lateral side of the deep uterine vein. The lateral type anatomy was observed unilaterally in 6 cases and bilaterally in 1 case. In summary, the lateral type anatomy was observed in 8 (29%) of 28 sides. In the cases evaluated by UDS, the positive predictive value of IES was 95% in group A and 100% in group B.


CONCLUSIONS
Our method of IES showed a high positive predictive value of nerve preservation as confirmed by UDS. By delineating the nerve tract in detail using IES, it is possible to individualize the operation based on each patient's anatomy, with an improved nerve preservation rate.
Department of Obstetrics and Gynecology, TohokuUniversity School of Medicine, 1-1 Seiryo-machi, Sendai, Japan.
Tomoyuki
T
Nagai
Hitoshi
H
Niikura
Hiroki
H
Kurosawa
Sota
S
Tanaka
Takeo
T
Otsuki
Hiroki
H
Utunomiya
Satoru
S
Nagase
Tadao
T
Takano
Kiyoshi
K
Ito
Yasuhiro
Y
Kaiho
Haruo
H
Nakagawa
Yoichi
Y
Arai
Nobuo
N
Yaegashi
D000230:Adenocarcinoma / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D004558:Electric Stimulation / Q000379:methods; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D007432:Intraoperative Period; D008875:Middle Aged; D008954:Models, Biological; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D057285:Precision Medicine / Q000379:methods*; D014551:Urinary Tract / Q000294:innervation / Q000503:physiopathology / Q000601:surgery; D014563:Urodynamics / Q000502:physiology; D014570:Urologic Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*