title: Nerve-sparing abdominal radical trachelectomy: a novel concept to preserve uterine branches of pelvic nerves.
abstract: OBJECTIVE
  Nerve-sparing techniques to avoid bladder dysfunction in abdominal radical hysterectomy have been established during the past two decades, and they have been applied to radical trachelectomy. Although trachelectomy retains the uterine corpus, no report mentions the preservation of uterine branches of pelvic nerves. The aim of the present study was to introduce and discuss our unique concept for preserving them.
  
  
  RESULTS
  Four cases with FIGO stage Ia2-Ib1 cervical cancer, in which preservation of uterine branches of the pelvic nerves was attempted, are presented. Operative procedures basically followed the previously reported standard approaches for nerve-sparing radical hysterectomy or trachelectomy, except for some points. Before resection of the sacrouterine ligament, the hypogastric nerve was first identified and translocated laterally. Subsequently, the uterine branches of the pelvic nerve were identified as a continuation of the hypogastric nerve and could be scooped with forceps by detachment of the surrounding connective tissues. Further detachment toward the uterine corpus enabled them to be completely separated from the cervix. This separation was extended up to the level of the junction of the upper and lower branches of the uterine artery. Thereafter, standard resection of the parametrium and paracolpium was performed, followed by cervical resection when it was confirmed that the isolated uterine branches of the pelvic nerves were safely translocated and preserved. There were no recurrences of cancer in these patients.
  
  
  CONCLUSIONS
  Uterine branches of autonomic nerves can be safely preserved, and the procedure may be considered one of the nerve-sparing techniques for radical abdominal trachelectomy, which may hopefully improve the reproductive outcomes of this operation, although it needs to be evaluated with more patients.
authors.affiliation: Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, 89-1 Enyacho, Izumo, Shimane 693-8501, Japan. Electronic address: satoruky@med.shimane-u.ac.jp.
authors.forename: Satoru
authors.initials: S
authors.lastname: Kyo
authors.affiliation: Department of Obstetrics and Gynecology, Kanazawa University School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, Japan.
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Mizumoto
authors.affiliation: Department of Obstetrics and Gynecology, Kanazawa University School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Takakura
authors.affiliation: Department of Obstetrics and Gynecology, Kanazawa University School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, Japan.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, 89-1 Enyacho, Izumo, Shimane 693-8501, Japan.
authors.forename: Emi
authors.initials: E
authors.lastname: Sato
authors.affiliation: Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, 89-1 Enyacho, Izumo, Shimane 693-8501, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Katagiri
authors.affiliation: Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, 89-1 Enyacho, Izumo, Shimane 693-8501, Japan.
authors.forename: Masako
authors.initials: M
authors.lastname: Ishikawa
authors.affiliation: Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, 89-1 Enyacho, Izumo, Shimane 693-8501, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Nakayama
authors.affiliation: Department of Obstetrics and Gynecology, Kanazawa University School of Medical Science, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujiwara
mesh_terms: D005260:Female; D006801:Humans; D007001:Hypogastric Plexus; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments / Q000379:methods*; D000069339:Trachelectomy / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery*; D014599:Uterus / Q000294:innervation*
keywords: Autonomic nerve; Cervical cancer; Nerve-sparing; Trachelectomy; Uterine branch