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Nerve-Sparing Radical Hysterectomy Made Easy by Laparoscopy
Abstract
Nerve Sparing radical hysterectomy made easy by laparoscopyBody: The commonest complication of a radical hysterectomy is bladder dysfunction. To overcome this, a nerve sparing radical hysterectomy is done. The advantage of performing a nerve sparing radical hysterectomy by laparoscopy is better delineation of nerves due to the magnification enabled by a laparoscope, thus leading to better nerve preservation.
To evaluate the technical feasibility of nerve sparing radical hysterectomy performed laparoscopically.
We performed laparoscopic nerve sparing radical hysterectomy in 35 patients with cancer cervix stage Ia1 and Ib1.
The oncological results were comparable to the conventional laparoscopic radical hysterectomy. Complete recovery of bladder functions after removal of Foleys catheter. Urodynamic studies performed after three weeks normal.
The oncological and functional results comparable to the conventional laparoscopic radical hysterectomy. This shows that magnification enabled by laparoscope helps in better dissection and preservation of nerve anatomy.
... The results of this study have suggested that LNSRH takes a longer time compared with LRH, mainly because this operation requires the surgeon to be meticulous, and the pelvic autonomic nerve needs to be carefully identified and isolated during the operation to protect the pelvic autonomy nerve [26]. The duration of LNSRH is longer than LRH, but with advancement of operative skills, the procedure can be optimized and the operation time can be shortened [28]. ...
Background
The effects and safety of laparoscopic nerve‑sparing radical hysterectomy (LNSRH) and laparoscopic radical hysterectomy (LRH) in cervical cancer treatment remain unclear. This article aims to evaluate the role of LNSRH versus LRH in the treatment of cervical cancer. This is because the updated meta-analysis with synthesized data may provide more reliable evidence on the role of LNSRH and LRH.
Methods
We searched Pubmed et al. databases for randomized controlled trials (RCTs) involving laparoscopic nerve‑sparing radical hysterectomy (LNSRH) and laparoscopic radical hysterectomy (LRH) for cervical cancer treatment from the inception of databases to June 15, 2021. The RevMan 5.3 software was used for data analyses. This meta-analysis protocol had been registered online (available at: https://inplasy.com/inplasy-2021-9-0047/ ).
Results
Thirteen RCTs involving a total of 1002 cervical cancer patients were included. Synthesized results indicated that the duration of surgery of the LNSRH group was significantly longer than that of the LRH group [SMD 1.11, 95% CI (0.15 ~ 2.07), P = 0.02]. The time to intestinal function recovery [SMD −1.27, 95% CI (−1.84 ~ −0.69), P < 0.001] and the time to postoperative urinary catheter removal of the LNSRH group [SMD −1.24, 95% CI (−1.62 ~ −0.86), P < 0.001] were significantly less than that of the LRH group. There were no significant differences in the estimated blood loss [SMD 0.10, 95% CI (−0.14 ~ 0.34), P = 0.41], the length of parauterine tissue resection [SMD −0.10, 95% CI (−0.25 ~ 0.05), P = 0.19], length of vaginal excision [SMD 0.04, 95% CI (−0.26 ~ 0.34), P = 0.78], and incidence of intraoperative adverse events [RR 0.97, 95% CI (0.44 ~ 2.13), P = 0.94] between the LNSRH group and the LRH group.
Conclusions
LNSRH significantly results in earlier bladder and bowel function after surgery. Limited by sample size, LNSRH should be considered with caution in the future.
... Short-term recovery of bladder and bowel function appeared delayed in the LRH cohort. An increasing number of studies support the fact that laparoscopic [12] and more so robotic [13] surgery facilitate nerve sparing surgical techniques, where branches of the inferior hypogastric plexus are actively sought and preserved. It is suggested that nerve sparing surgery offers better functional postoperative recovery of the pelvic organs [14]. ...
Objective . To compare the safety, efficacy, and direct cost during the introduction of laparoscopic radical hysterectomy within an enhanced recovery pathway. Methods . A 1 : 1 single centre retrospective case control study of 36 propensity matched pairs of patients receiving open or laparoscopic surgery for early cervical cancer. Results . There were no significant differences in the baseline characteristics of the two cohorts. Open surgery cohort had significantly higher intraoperative blood loss (189 versus 934 mL) and longer postoperative hospital stay (2.3 versus 4.1 days). Although no significant difference in the intraoperative or postoperative complications was found more urinary tract injuries were recorded in the laparoscopic cohort. Laparoscopic surgery had significantly longer duration (206 versus 159 minutes), lower lymph node harvest (12.6 versus 16.9), and slower bladder function recovery. The median direct hospital cost was £4850 for laparoscopic radical hysterectomy and £4400 for open surgery. Conclusions . Laparoscopic radical hysterectomy can be safely introduced in an enhanced recovery environment without significant increase in perioperative morbidity. The 10% higher direct hospital cost is not statistically significant and is expected to even out when indirect costs are included.
... A recent study has shown that this technique is associated to lower anorectal dysfunction 26 . Another long-term study showed that laparoscopy for radical hysterectomy improves nervous dissection and preservation due to the better magnification 27 . ...
Cervical cancer remains the most frequent gynecological tumor in Brazil and other developing countries. Minimally invasive techniques, especially laparoscopy, have been increasingly employed in such tumors. This article aims to describe the main applications of laparoscopy in the treatment and staging of cervical cancer. In the early stages, it is possible to provide a fertility-preserving surgery in the form of radical trachelectomy and, in a study protocol, the function-preserving surgery, avoiding parametrectomy and the associated morbidity. A fully laparoscopic radical hysterectomy is fairly standard in the literature and has the tendency to become the standard of care in early cases, for patients who want to bear no more children. In advanced stages, minimally invasive surgery can offer ovarian transposition, with intent to prevent actinic castration, without upsetting the time for the start of radiotherapy and chemotherapy. Staging laparoscopic surgery, including pelvic and para-aortic lymphadenectomy, has been the subject of studies, since it has the potential to modify the extension of radiotherapy depending on the extent of lymph node spread.
IntroductionEndometriosis is the condition in which there are ectopic endometrial tissues outside the uterine cavity. The use of nerve sparing technique has been well established in the field of oncology, leading to better quality of life following radical oncologic procedures without compromising on the long-term survival. The objective of this study is to compare the quality of life in terms of sexual function and urinary function in women undergoing nerve sparing surgeries for endometriosis and those undergoing non-nerve sparing surgeries.Material and Methods
Data of 51 patients operated for endometriosis at Galaxy Care Laparoscopic Institute, Pune, India between 1st January 2020 till 31st December 2020 were collected and analysed. We included patients in age group between 38 and 44 years in monogamous relationship, with moderate to severe endometriosis (Revised American Society of Reproductive Medicine r-ASRM score of 16 and above 5), being operated for hysterectomy along with ureterolysis and/or bowel resection (including shaving of rectal endometriosis, discoid resection, segmental resection), and excision of large ovarian endometriomas (> 3 cm size) with cul-de-sac obliteration.ResultsThe patients were evaluated for the following factors: age, parity, nature of surgery done, immediate intraoperative complications (bowel injury, bladder injury, ureteric injury), operative time in minutes, average blood loss, length of hospital stay, days to removal of foley’s catheter and postoperative urinary and sexual function which were assessed on follow up visit and a 1-year follow up interview. We found that the urinary and sexual function in the group undergoing nerve sparing surgeries was significantly better than the patients undergoing non-nerve sparing surgeries.Conclusion
Laparoscopic nerve sparing approach for clearance of endometriosis has allowed better quality of life post surgery. Proper understanding and demonstration of pelvic neuroanatomy has made this approach feasible and achievable in carefully selected patients.
This review aims to analyse and describe the current role of laparoscopy in the treatment of cervical cancer. Laparoscopy has become an important tool in gynaecological oncology. Its general advantages in comparison with open surgery apply to oncological patients as much as they do to benign conditions. Data from retrospective and case-control studies have proven that treatment of early cervical carcinoma is successfully feasible by means of minimally invasive surgery with no compromise of oncological principles nor radicality. Thus, laparoscopy has entered guideline recommendations as an alternative to open procedures when operative therapy is indicated. Nevertheless, laparoscopic radical hysterectomy, as well as lymphadenectomy, remain demanding and require surgeons experienced in both operative oncology and endoscopy.
Aims:
This study aimed to evaluate the feasibility and outcomes of patients with advanced cervical cancer treated with definitive concurrent chemoradiotherapy followed by Type C 1 nerve-sparing radical hysterectomy.
Settings and design:
This is a prospective study to assess the feasibility of Type C 1 nerve-sparing radical hysterectomy postdefinitive chemoradiation in advanced carcinoma cervix.
Subjects and methods:
We analyzed 25 patients with cervical cancer evaluated and treated with concurrent chemoradiation followed by surgery. Twenty patients underwent Type C 1 nerve-sparing radical hysterectomy by open surgery and five patients by laparoscopic approach. Postoperative morbidity and pathology were analyzed.
Statistical analysis used:
Analysis of the outcomes was done by arithmetical calculations.
Results:
Eight patients (32%) had persistent residual disease after definitive chemoradiation followed by surgery. Rest of the patients had pathological complete response. Two patients (8%) had node-positive disease. None of the patients in the laparoscopic group had bladder morbidity. One patient in the laparoscopic group had persistent vaginal discharge.
Conclusions:
Type C1 nerve-sparing radical hysterectomy is technically feasible with minimal morbidity following definitive chemoradiation in advanced squamous cell carcinoma of the cervix.
Introduction and hypothesis
Nerve-sparing radical hysterectomy (NSRH) has been developed as a method of cervical cancer treatment to reduce surgical morbidity compared with radical abdominal hysterectomy. The aim of this study was to analyze the short- and long-term effects of NSRH on urinary tract function.
Methods
A study group of 117 patients underwent NSRH type C1 with pelvic lymphadenectomy for cervical cancer stages IB1–IB2 without adjuvant radiotherapy at our department. A total of 106 patients aged 21–74 years (mean age 44.8) were available for follow-up at 1 year after surgery. A transurethral catheter was left in place for 48 h after surgery, and the postvoid residual (PVR) volume was measured after its removal. One week before surgery and 12 months after NSRH, lower urinary tract function was evaluated by an urodynamic examination.
Results
Five days after surgery, the PVR volume was greater than 100 ml in 5 patients (4.7%) and a suprapubic catheter was inserted into these women for bladder training over the following days. Within 14 days after surgery, urination without PVR was achieved in all women who underwent surgery. Postoperatively, a slight increase in the average maximum bladder cystometric capacity was recorded from 420 to 445 ml (p value 0.009) without prolonging the voiding time. Other urodynamic parameters were not significantly different before and 12 months after NSRH.
Conclusions
In this series, NSRH preserved voiding function and bladder sensation at 1 year and did not appear to compromise oncological outcome.
Uterine malignancies are a common cause of cancer death amongst women. The incidence has risen in the recent years because of increasing awareness and screening [1, 2]. Radical hysterectomy continues to be the most common surgical approach in treatment of an early stage carcinoma of the cervix and endometrium.
Objective:
To evaluate the feasibility and safety of laparoscopic nerve-sparing radical hysterectomy (LNRH) for locally advanced cervical cancer (LACC) after neoadjuvant chemotherapy (NACT).
Methods:
120 patients with stage Ib2 and IIa2 cervical cancer were treated with surgery combined with preoperative NACT in the Department of Obstetrics and Gynecology, PLA General Hospital. Eligible patients were divided into two groups according to surgery type: patients who underwent LNRH were assigned to one group, while the second group included patients who underwent laparoscopic radical hysterectomy (LRH) after administration of NACT. We compared these patients' general clinical information and surgical characteristics, and we assessed their bladder function and intestinal function recovery by questionnaire.
Results:
No significant differences were found between the groups in patients' age or surgical characteristics. The mean duration of postoperative catheterization in the LNRH group was shorter than in the LRH group (P < 0.001). The intestinal and bladder function of patients in the LNRH group also recovered better than that of patients in the LRH group.
Conclusion:
LNRH is a feasible and safe procedure for LACC after NACT and reduces surgical complications.
To investigate the safety, feasibility and effectiveness of laparoscopic approach in the management patients undergoing modified radical hysterectomy for early stage cervical cancer.
Consecutive data of 157 women who had class II radical hysterectomy, for stage IA2 and stage IB1 <2 cm cervical cancer, were prospectively collected. Data of patients undergoing surgery via laparoscopy (LRH) were compared with those undergoing open surgical operations (RAH). A propensity-matched comparison (1:1) was carried out to minimize as possible selection biases. Post-operative complications were graded per the Clavien-Dindo classification. Five-year survival outcomes were assessed using Kaplan-Meier model.
After the exclusion of 37 (23.5%) patients on the basis of propensity-matching, 60 patients undergoing LRH were compared with 60 patients undergoing RAH. No between-group differences in baseline, disease and pathological variables were observed (p > 0.05). Patients undergoing surgery via laparoscopy experienced longer operative time than patients undergoing RAH; while LRH correlated whit shorter length of hospitalization and lower blood loss in comparison to RAH. Intra- and post-operative complication rate was similar between groups (p = 1.00). The execution of LRH or RAH did not influence site of recurrence (p > 0.2) as well as survival outcomes, in term of 5-year disease-free (p = 0.29, log-rank test) and overall survivals (p = 0.50, log-rank test).
Laparoscopic approach is a safe procedure, upholds the results of RAH, reducing invasiveness of open surgical operations. Further large prospective investigations are warranted.
Copyright © 2014 Elsevier Ltd. All rights reserved.
Aim:
To investigate whether perioperative outcomes of class III/type C laparoscopic radical hysterectomy (LRH) for cervical cancer (CC) are influenced by neoadjuvant chemotherapy (NACT).
Patients and methods:
Data of consecutive patients, affected by locally advanced-stage CC, undergoing NACT plus LRH were matched 1:2 with consecutive patients, affected by early-stage CC who underwent LRH without NACT.
Results:
Twenty and 40 patients underwent NACT with LRH and LRH aIone, respectively. Demographic characteristics were balanced between groups. Number of lymph nodes yielded, parametrial width and length of vaginal cuff were not influenced by preoperative administration of NACT. Patients undergoing NACT plus LRH experienced slightly higher blood loss (225 vs. 200 ml; p=0.05) than patients in the control group, but had a similar operative time and length of hospital stay. No between-group differences in transfusion and complications rates were observed (p>0.2).
Conclusion:
The administration of NACT does not affect the surgery-related outcomes of LRH.
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