title: Nerve-sparing approach reduces sexual dysfunction in patients undergoing laparoscopic radical hysterectomy.
abstract: BACKGROUND
  Although growing evidence suggests the beneficial effects of a nerve-sparing (NS) approach to surgery in cervical cancer patients, only limited data on NS laparoscopic radical hysterectomy (LRH) are available, and no studies have investigated the effects of NS-LRH on sexual function.
  
  
  OBJECTIVE
  This study aims to determine whether the implementation of NS-LRH impacts on sexual function in cervical cancer patients.
  
  
  METHODS
  Sexually active cervical cancer patients undergoing type C (class III) LRH between 2004 and 2013 were enrolled in this prospective study.
  
  
  METHODS
  Preoperative and postoperative sexual function were assessed using a validated questionnaire, the Female Sexual Function Index (FSFI). The FSFI evaluates desire, arousal, lubrication, orgasm, satisfaction, and pain.
  
  
  RESULTS
  Forty patients undergoing radical hysterectomy (20 conventional LRH vs. 20 NS-LRH) represented the study group. Baseline characteristics were similar between groups (P > 0.05). No differences in preoperative FSFI scores were recorded (P > 0.05). We observed that both LRH and NS-LRH worsened postoperative FSFI scores (P < 0.001). However, patients undergoing NS-LRH had higher postoperative FSFI scores than patients undergoing LRH (21.3 ± 9.4 vs. 14.2 ± 12.5; P = 0.04). Considering postoperative domain scores, we observed that desire, arousal, orgasm, and pain scores were similar between groups (P > 0.05), while patients undergoing NS-LRH experienced higher lubrication (3.4 ± 2.3 vs. 1.7 ± 2.2; P = 0.02) and satisfaction (4.6 ± 3.9 vs. 2.8 ± 2.2; P = 0.004) scores in comparison with patients undergoing conventional LRH. No between-group differences in survival outcomes were found.
  
  
  CONCLUSIONS
  Both conventional LRH and NS-LRH impact negatively on patients' sexual function. However, the NS approach impairs sexual function less, minimizing the effects of radical surgery.
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bogani
authors.forename: Maurizio
authors.initials: M
authors.lastname: Serati
authors.forename: Rossella
authors.initials: R
authors.lastname: Nappi
authors.forename: Antonella
authors.initials: A
authors.lastname: Cromi
authors.forename: Edoardo
authors.initials: E
authors.lastname: di Naro
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghezzi
mesh_terms: D000328:Adult; D000368:Aged; D001143:Arousal / Q000502:physiology; D004414:Dyspareunia / Q000517:prevention & control; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D007989:Libido; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000379:methods*; D009948:Orgasm / Q000502:physiology; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012735:Sexual Dysfunction, Physiological / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D020196:Trauma, Nervous System / Q000517:prevention & control*; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000601:surgery
keywords: Female Sexual Function Index; Laparoscopy; Nerve Sparing; Radical Hysterectomy; Sexual Function