Simplified robot assisted nerve sparing radical hysterectomy for small volume cervical cancer

Article information

Gyne Robot Surg. 2023;4(1):22-23

Publication date (electronic) : 2023 March 25

doi : https://doi.org/10.36637/grs.2022.00136

Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondening author: Dae-Yeon Kim Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, Songpa-gu, Seoul 05505, Korea E-mail: kdyog@amc.seoul.kr

Received 2022 September 30; Revised 2023 February 1; Accepted 2023 March 3.

Keywords: Uterine cervical cancer; Robotic surgical procedures; Hysterectomy; Nerve; Sparing

Radical hysterectomy is a standard treatment method for early cervical cancer in those who do not need fertility sparing [1]. Bladder dysfunction and sexual disorder are the most common complications due to pelvic autonomous nerve injury during radical hysterectomy [2]. Nerve-sparing radical hysterectomy is a technique that reduces complications of conventional radical hysterectomy by preserving the pelvic autonomous nerve system, including the hypogastric nerve, pelvic splanchnic nerve, and inferior hypogastric nerve [3]. As there has been a paradigm shift in cervical cancer surgery from uniform to tailored radical surgery, nerve-sparing radical hysterectomy has widely been performed in the clinical field [4]. However, the techniques for nerve-sparing radical hysterectomy are not standardized, and complicated pelvic nerve anatomy makes performing nerve-sparing radical hysterectomy challenging for most surgeons [5]. Herein, we report a case report of a practical nerve-sparing method with robot radical hysterectomy for cervical cancer treatment.

A 51-year-old woman who was diagnosed with cervical cancer International Federation of Gynecology and Obstetrics stage Ia2 underwent a nerve-sparing robot radical hysterectomy. The da Vinci^® Xi Surgical system (Intuitive Surgical, Sunnyvale, CA, USA) platform was used for the surgery. After developing the pararectal space caudally from the infundibulopelvic ligament level, both hypogastric nerves were separated laterally from the sacrouterine and rectouterine ligaments. The separated nerves were taped with a rubber band. During the radical hysterectomy procedure, both hypogastric nerves were easily identified, and nerve damage was avoided.

There was no voiding difficulty after removing the foley catheter. The patient was discharged without any complications associated with the surgery. The resection margin was free of the tumor with no metastasis in the lymph nodes.

This simplified technique of nerve-sparing robot radical hysterectomy is a feasible option for cervical cancer treatment.

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Notes

Conflict of interest

No potential conflict of interest relevant to this article was reported.

References

1. Brandt B, Levin G, Leitao MM Jr. Radical hysterectomy for cervical cancer: the right surgical approach. Curr Treat Options Oncol 2022;23:1–14.

2. Ayhan A, Tuncer ZS, Yarali H. Complications of radical hysterectomy in women with early stage cervical cancer: clinical analysis of 270 cases. Eur J Surg Oncol 1991;17:492–4.

3. Sakuragi N, Murakami G, Konno Y, Kaneuchi M, Watari H. Nervesparing radical hysterectomy in the precision surgery for cervical cancer. J Gynecol Oncol 2020;31e49.

4. Sakuragi N, Kaneuchi M, Kato T, Shimada C, Todo Y, Ihira K, et al. Tailored radical hysterectomy for locally advanced cervical cancer. Int J Gynecol Cancer 2020;30:1136–42.

5. Muallem MZ, Diab Y, Sehouli J, Fujii S. Nerve-sparing radical hysterectomy: steps to standardize surgical technique. Int J Gynecol Cancer 2019;29:1203–8.

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