Classical and nerve-sparing radical hysterectomy: An evaluation of the risk of injury to the autonomous pelvic nerves

A. Ercoli, V. Delmas, P. Gadonneix, F. Fanfani, R. Villet, P. Paparella, S. Mancuso, Giovanni Scambia

Research output: Contribution to journalArticlepeer-review

Abstract

Radical hysterectomy represents the treatment of choice for FIGO stage IA2-IIA cervical cancer. It is associated with several serious complications such as urinary and anorectal dysfunction due to surgical trauma to the autonomous nervous system. In order to determine those surgical steps involving the risk of nerve injury during both classical and nerve-sparing radical hysterectomy, we investigated the relationships between pelvic fascial, vascular and nervous structures in a large series of embalmed and fresh female cadavers. We showed that the extent of potential denervation after classical radical hysterectomy is directly correlated with the radicality of the operation. The surgical steps that carry a high risk of nerve injury are the resection of the uterosacral and vesicouterine ligaments and of the paracervix. A nerve-sparing approach to radical hysterectomy for cervical cancer is feasible if specific resection limits, such as the deep uterine vein, are carefully identified and respected. However, a nerve-sparing surgical effort should be balanced with the oncological priorities of removal of disease and all its potential routes of local spread.

Original languageEnglish
Pages (from-to)200-206
Number of pages7
JournalSurgical and Radiologic Anatomy
Volume25
Issue number3-4
DOIs
Publication statusPublished - Jul 2003

Keywords

  • Nerve-sparing
  • Pelvic plexus
  • Pelvic splanchnic nerves
  • Radical hysterectomy

ASJC Scopus subject areas

  • Anatomy
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

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