Nerve-Sparing Modified Radical Hysterectomy for Severe Endometriosis and Complex Pelvic Pathology

Nezhat, Camran; Nguyen, Kimsa; Ackroyd, Eliza; Roman, Robert; Rambhatla, Anupama; Nezhat, Azadeh; Asiaii, Atena

doi:10.7759/cureus.9882

Cited by 7 publications

(10 citation statements)

References 24 publications

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Section: Discussionsupporting

confidence: 92%

“…However, despite a nerve-sparing approach for parametrial resection, post-operative bladder voiding deficit was frequently reported. This finding is in line with results reported in the literature, where the incidence of post-operative bladder dysfunction requiring self-catheterisation was one of the most frequent complications (Ballester et al, 2011;Uccella et al, 2018;Nezhat et al, 2020). Ballester et al (2011) reported a selfcatheterisation incidence of 37% during the immediate postoperative period and the need for bladder catheterisation in 12.5% of patients over a 3-month follow-up period.…”

Section: Discussionsupporting

confidence: 90%

“…Uccella et al (2018) analysed the functional outcome of nerve-sparing DE eradication and observed that 11.8% of patients experienced urinary retention immediately after surgery, with spontaneous improvement in all patients. Nezhat et al (2020) investigated the postoperative complication rate following the modified radical hysterectomy for DE and reported urinary retention in 0.9% of cases. However, this finding is difficult to interpret due to the lack of a standardised classification of parametrial resection for DE.…”

Section: Discussionmentioning

confidence: 99%

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Surgical and functional impact of nerve-sparing radical hysterectomy for parametrial deep endometriosis: a single centre experience

Rosati¹,

Pavone²,

Campolo³

et al. 2022

Facts Views Vis ObGyn

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Background: Deep endometriosis (DE) usually creates a distortion of the retroperitoneal anatomy and may infiltrate the parametria with an oncomimetic pathway similar to cervical cancer. The condition represents a severe manifestation of endometriosis that may result in a functional impairment of the inferior hypogastric plexus. An extensive surgical resection may be required with an associated risk of increased neurogenic postoperative pelvic organ dysfunction. Objectives: To evaluate the post-operative function and complications following hysterectomy with posterolateral parametrial resection for DE. Materials and Methods: In total, 23 patients underwent radical hysterectomy for DE with the parametria involved. The severity of pain was assessed by the Visual Analogue Scale (VAS) score. The KESS, GQLI, BFLUTS and FSFI were used to examine the gastrointestinal, urinary and sexual functions respectively. Intra and post-operative complications were recorded. Main outcome measures: The main outcomes were gastrointestinal, urinary and sexual function and intra and post-operative complications. Results: Dyschezia, dyspareunia and chronic pelvic pain were significantly reduced following hysterectomy. Furthermore, an improvement of gastrointestinal function was observed, while sexual functions, examined by FSFI and urinary symptoms, examined by BFLUTS, was not shown to be significant. Conclusion: The modified nerve-sparing radical hysterectomy for DE results in an improvement of symptoms. Nevertheless, despite the nerve-sparing approach, this procedure may be associated with a not-negligible risk of post-operative bladder voiding deficit. What is new? This is the first study that focuses on parametrial endometriosis using validated questionnaires to assess functional outcomes following radical hysterectomy for DE.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Surgical and functional impact of nerve-sparing radical hysterectomy for parametrial deep endometriosis: a single centre experience

Rosati¹,

Pavone²,

Campolo³

et al. 2022

Facts Views Vis ObGyn

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“…In necessary cases, inserting a double j-stent can make it easier to find the ureter in fibrosis tissue. In routine DE cases, it is claimed that routine lateralization of the ureters is sufficient to prevent intraoperative damage (11). Ureterolysis procedure is thought to be effective only in selected cases (<3 cm small lesion and superficial involvement).…”

Section: Discussionmentioning

confidence: 99%

Analysis of endometriosis cases and its surgery techniques in our clinic

Kale

uzun

Başol

et al. 2022

Preprint

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Aim: Endometriosis is a disease affecting women of fertile age, with an estimated more than 176 million women worldwide suffering from their symptoms, with no correlation between the degree and symptoms of the disease. Although the initial treatment in endometriosis is medical treatment, patients with severe symptoms are candidates for surgery as the last choice. We contribute to the literature by publishing our 15 cases and to discuss surgical treatment methods. Method: Patients operated due to the endometriozis in Kartal Dr Lutfı Kırdar Training and Research Hospital between January, 2019 and January, 2020 were evaluated. 15 patients were found according to the criteria. and discussed according to the literature. All patients’ age, body mass index, gravida, parity, medications, chronic diseases,, past surgical history, duration of diagnosis time, ultrasonograph results, clinical symptoms, physical examinations,surgical procedure, operation time, complications, hospital discharge time, preoperative and postoperative pain scores [10-cm visual analogue scale (VAS)] were analyzed Results: When the postoperative VAS scores were evaluated, it was found that the scores improved significantly compared to preoperative VAS scores. Intraoperatively, ureter damage in one patient and bowel damage in one patient were detected. Wound infection was detected as a postoperative complication in one patient. Conclusion: Operations performed by experienced teams in cases resistant to medical treatment in endometriosis benefit the patient, as well as operations performed by inexperienced hands may harm the patient. Therefore, we think that patients who need endometriosis surgery should be directed to experienced centers.

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“…Based on the understanding of tissue structure around the cervix and innervation, and the understanding of the shape, function, and innervation of the pelvic autonomic nerves, some scholars have proposed a radical resection of cervical cancer that preserves the pelvic nerves [ 7 ]. Laparoscopic radical hysterectomy (LRH) has the advantages of performing fine dissection, less intraoperative bleeding, superior surgical field visibility, less tissue trauma, and quicker recovery [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic nerve‑sparing radical hysterectomy for the treatment of cervical cancer: a meta-analysis of randomized controlled trials

Guo

et al. 2021

World J Surg Onc

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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.

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Nerve-Sparing Modified Radical Hysterectomy for Severe Endometriosis and Complex Pelvic Pathology

Cited by 7 publications

References 24 publications

Surgical and functional impact of nerve-sparing radical hysterectomy for parametrial deep endometriosis: a single centre experience

Surgical and functional impact of nerve-sparing radical hysterectomy for parametrial deep endometriosis: a single centre experience

Analysis of endometriosis cases and its surgery techniques in our clinic

Laparoscopic nerve‑sparing radical hysterectomy for the treatment of cervical cancer: a meta-analysis of randomized controlled trials

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