A New Anatomic and Staging-Oriented Classification of Radical Hysterectomy

Abstract

The current understanding of radical hysterectomy more is centered on the uterus and little is being discussed about the resection of the vaginal cuff and the paracolpium as an essential part of this procedure. This is because that the current classifications of radical hysterectomy are based only on the lateral extent of resection. This way is easier to be understood but does not reflect the anatomical and surgical conception of radical hysterectomy and the three-dimensional ways of tumour spreading, neither meet the need of adjusting the radicality according to the different stages of FIGO classification, which depends—at least in the early stages—on the tumour volume and the infiltration in the vagina (but not on the directly spread in the parametrium). The new classification presented in this paper does not base anymore on the lateral extent of resection only but too on the depth of resection in the small pelvic and the extent of the resected vaginal vault without or with its three-dimensional paracolpium. This classification takes into account the tumour size, stage, localization and infiltration in the vaginal vault and may offer the optimal tool to adjust and tailor the surgery according to these important variables.

Nerve sparing systematic lymph node dissection (para-aortic region): a technique for enhanced functional outcomes after gynecological cancer surgeries

“…We focus on the steps to dissect, visualize, and highlight the sympathetic trunks, the superior hypogastric plexus, the abdominal aortic plexus, and the intermesenteric nerves (Figure 1) during para-arotic lymph node dissection using an open approach. Other studies from our study group confirmed the feasibility of nerve sparing surgery during radical hysterectomy for cervical cancer and explained the precise anatomy of the pelvic autonomic nervous system 7–9. Nerve sparing para-aortic lymph node dissection is feasible and safe in gynecological cancer cases when following the steps outlined in the video for careful dissection of the aortic and superior hypogastric plexus 1 6.…”

“…Other studies from our study group confirmed the feasibility of nerve sparing surgery during radical hysterectomy for cervical cancer and explained the precise anatomy of the pelvic autonomic nervous system. [7][8][9] Nerve sparing para-aortic lymph node dissection is feasible and safe in gynecological cancer cases when following the steps outlined in the video for careful dissection of the aortic and superior hypogastric plexus. 1 6 Larger prospective trials are planned to assess the effects of this technique on postoperative functional patient reported outcomes.…”

Sentinel Lymph Node Staging with Indocyanine Green for Patients with Cervical Cancer: The Safety and Feasibility of Open Approach Using SPY-PHI Technique

“…The radical hysterectomies were performed nerve-sparingly according to our technique described in a previous study [ 28 ]. The radicality was adjusted to the tumor volume, localization, infiltration in the vagina, and FIGO-stage in accordance with the Muallem classification of radical hysterectomy [ 30 ]. The statistical analysis was performed at the Charité Medical University Berlin.…”

The Impact of Surgical Practice on Oncological Outcomes in Robot-Assisted Radical Hysterectomy for Early-Stage Cervical Cancer, Spanish National Registry

“…In this regard, the evolution of the radical hysterectomy technique [7][8][9][10][11][12] since its first description in 1912 [13] reflects the challenges that have been associated with this surgery. Very recently, a new classification of radical hysterectomy has been postulated considering the lateral extent of parametrium resection and the depth of resection of the resected vaginal vault without or with its threedimensional paracolpium [14]. However, the impact of surgical practice on oncological outcomes after robot-assisted radical hysterectomies remains unclear.…”