1. Nerve Sparing Radical Hysterectomy
Dr. Nisreen Anfinan

2. Cervical cancer
ž Cervical cancer second common cancer
in women worldwide
ž Radical hysterectomy for early stage

3. Early stage
cervical cancer beyond
micro-invasion
Radical hysterectomy
+
PPLND
Advance stage
cervical cancer
Radiotherapy
+
Chemotherapy
Cancer cervical

4. Radical hysterectomy
ž Uterus
ž Parametrium
ž Upper vagina
ž Pelvic lymphadenectomy

5. Pelvic Lymph nodes

6. Pelvic lymphadenectomy

10. Acollaged visceral surface
± Septums
ü Vesico-uterine
ü Vesico-vaginal
ü Recto-vaginal ± Pelvic spaces
ü Paravesical
ü Pararectal
ü Retropubic of
Retzius
ü Retrorectal

13. Para vesical

20. Vesicouterine ligamnet

21. Morbidity (Landoni et al. 2000, 243 pts)

22. Nerve Sparing Radical
Hysterectomy

23. « Nerve Sparing » in Gynaecology
autonomic innervation conservation
ž • Sakamoto 1980 (laparotomy)
ž • Hoeckel 1998 (laparotomy)
ž • Possover 1999 (laparoscopic assisted vaginal
route)
ž • Maas,Trimbos 2000 (laparotomy)
ž • Kuwabara 2000 (laparotomy)
ž • Kato, Murakami,Yabuki 2000-2003 (laparotomy)
ž • Querleu 2002 (laparoscopic assisted vaginal
route)
ž • Raspagliesi 2004 (laparotomy)
ž • Sakuragi 2005

24. Pelvic Autonomic Innervation
² Sympathetic system
ü Superior hypogastric plexus
ü Hypogastric nerves
² Paraympathetic system
ü Pelvic splanchnic nerves
² Inferior hypogastric plexus
² Visceral nerve branches

25. ² Sympathetic system
ü Superior hypogastric plexus
ü Hypogastric nerves
² Paraympathetic system
ü Pelvic splanchnic nerves
² Inferior hypogastric plexus
² Visceral nerve branches
Pelvic Autonomic Innervation

30. Nerve sparing radical hystrectomy
ž To assess the (NSRH) technique and its impact on postoperative
voiding function.
ž Forty-four patients with stage I b1-IIa cervical cancer
22 NSRH
22 CRH
ž Operative time in NSRH group and CRH group were (329 +/- 43)
min and (272 +/- 56) min
ž Post-void residual urine volume on day 8 after surgery < 100 ml
(68% vs. 18%, P < 0.01).
ž The median duration of postoperative catheterization was
significantly shorter in NRSH group (8/20 days; P < 0.01).
li etal Zhonghua Fu Chan Ke Za Zhi. 2008 Aug;43(8):
606-10

31. Conclusion
ž Knowledge of the retroperitoneal
anatomy is essential to the success
in advanced gynecologic surgery
ž NSRH has been proposed as a possible
technique to identify and preserve good
oncologic outcome

32. Thank you