Role of the two-point pull-up technique for treating the uterine arteries during radical hysterectomy and trachelectomy

Abstract

Objectives: To introduce a safe and reliable method for the management of peripheral vessels around the uterine artery during abdominal radical hysterectomy or abdominal radical trachelectomy.

Study design: From 2007 to 2011, 102 patients with invasive cervical cancer underwent an abdominal radical hysterectomy. In 48 operations in 2007-2009, we performed the conventional radical hysterectomy, in which we ligated and cut the uterine arteries at their origin, and we divided the anterior leaf of the vesico-uterine ligament by blindly inserting scissors into the ureteral tunnel, pushing the ureter laterally from the cervix. In 54 operations in 2009-2011, we pulled up the origin and the bifurcation of the uterine artery using vessel tape, skeletonized the uterine artery and directly divided the superficial uterine vein, superior vesical vein and ureteric branch of the uterine artery. We also performed four radical trachelectomies using the two point pull-up method. We investigated whether this method was useful for the management of peripheral vessels around the uterine artery.

Results: The mean total blood loss in the two point pull-up method group (485 ± 270 ml) was significantly lower than that in the conventional surgery group (686 ± 554 ml) (p<0.05). The mean length of the operation in the two point pull-up method group (481 ± 53 min) was not significantly different from the conventional surgery group (497 ± 74 min) (p=0.111). The mean number of dissected lymph nodes in the two point pull-up method group (37.2 ± 11.6) was not significantly different from that in the conventional method group (34.4 ± 10.2) (p=0.096). The overall survival and progression-free survival were also not substantially different between the two groups. In the radical trachelectomy, the mean blood loss was 377.5 ± 185.6 ml and the mean duration of surgery was 520.0 ± 48.5 min using the two point pull-up method. We were able to preserve both uterine arteries without accidental injury or disruptive bleeding. All four patients were menstruating normally as of the last examination.

Conclusions: The two point pull-up method enabled us to reduce intraoperative blood loss without increasing other complications during abdominal radical hysterectomy or abdominal radical trachelectomy.

Keywords: Abdominal radical trachelectomy; Cervical cancer; Cervicovesical vessels; Fertility-sparing procedure; Radical hysterectomy.