Magnifying lenses assisted nerve-sparing radical hysterectomy and prevention of nerve plexus trauma

Int J Gynecol Cancer. 2008 Jul-Aug;18(4):868-75. doi: 10.1111/j.1525-1438.2007.01071.x. Epub 2007 Sep 24.

Abstract

The objectives of the study were to present a new approach for nerve-sparing radical hysterectomy (NSRH) with the assistance of magnifying lenses and to describe the differences in autonomic nerve plexus trauma between NSRH type III and conventional radical hysterectomy (RH) types II and III with the aid of immunohistochemistry. Eighteen women with FIGO stage IB(1)-IB(2) cervical cancer underwent loupes-assisted NSRH (n = 8), RH type II (n = 6), and RH type III (n = 4). Biopsies were taken intraoperatively from uterosacral ligament (USL) and cardinal ligament (CL), as well as from anterior vaginal wall (AVW) and posterior vaginal wall (PVW). Immunohistochemistry was approached with the use of S-100 protein, a general nerve marker. The percentage area of immunoreactivity (PAI) was used as an objective quantitative measure of nerve fibers within the ligaments. The PAI was greater in RH-III biopsies from both USL and CL (P < 0.001) when compared with RH-II and NSRH biopsies. For AVW and PVW, PAI differences were not statistically significant (AVW, P = 0.119; PVW, P = 0.067). Uterine-supporting ligaments represent a major pathway for autonomic nerves to the pelvic organs. As significantly more autonomic nerves are transected during the division of the uterine-supporting ligaments in RH type III, a more careful approach in the dissection of the ligaments through nerve-preserving techniques seems to be necessary in order to prevent iatrogenic intraoperative injury of the pelvic plexus and reduce or prevent postoperative complications.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Carcinoma / metabolism
  • Carcinoma / pathology
  • Carcinoma / surgery
  • Female
  • Humans
  • Hypogastric Plexus / injuries
  • Hypogastric Plexus / metabolism
  • Hypogastric Plexus / surgery*
  • Hysterectomy / instrumentation*
  • Hysterectomy / methods*
  • Immunohistochemistry
  • Lenses*
  • Lymph Node Excision
  • Lymphatic Metastasis
  • Middle Aged
  • Neoplasm Invasiveness
  • Postoperative Complications / prevention & control
  • S100 Proteins / metabolism
  • Trauma, Nervous System / prevention & control*
  • Uterine Neoplasms / metabolism
  • Uterine Neoplasms / pathology
  • Uterine Neoplasms / surgery
  • Uterus / innervation
  • Uterus / metabolism

Substances

  • S100 Proteins