Background In order to simplify the complicated procedure of nerve-sparing radical hysterectomy, a novel technique characterized by integral preservation of the autonomic nerve plane has been employed for invasive cer...Background In order to simplify the complicated procedure of nerve-sparing radical hysterectomy, a novel technique characterized by integral preservation of the autonomic nerve plane has been employed for invasive cervical cancer. The objective of this study was to introduce the nerve plane-sparing radical hysterectomy technique and compare its efficacy and safety with that of nerve-sparing radical hysterectomy. Methods From September 2006 to August 2010, 73 consecutive patients with International Federation of Gynecology and Obstetrics stage IB to IIA cervical cancer underwent radical hysterectomy with two different nerve-sparing approaches. Nerve-sparing radical hysterectomy was performed for the first 16 patients （nerve-sparing radical hysterectomy group）. The detailed autenomic nerve structures were identified and separated by meticulous dissection during this procedure. After January 2008, the nerve plane-sparing radical hysterectomy procedure was developed and performed for the next 57 patients （nerve plane-sparing radical hysterectomy group）. During this modified procedure, the nerve plane （meso-ureter and its extens;ion） containing most of the autonomic nerve structures was integrally preserved. The patients＇ clinicopathologic characteristics, surgical parameters, and outcomes of postoperative bladder function were compared between the two groups. Results There were no significant differences between the nerve plane-sparing radical hysterectomy and nerve-sparing radical hysterectomy groups regarding age, International Federation of Gynecology and Obstetrics stage, pathological type, preoperative treatment, or need for intraoperative blood transfusion. The nerve plane-sparing radical hysterectomy group had a higher body mass index than that of the nerve-sparing radical hysterectomy group （P=0.028）. The mean surgical duration in the nerve plane-sparing radical hysterectomy and nerve-sparing radical hysterectomy groups were （262_＋46） minutes and （341＋36） minutes （P 〈0.01）.展开更多
Objective: The aim of this study was to investigate the feasibility of using ultrasonic scalpel combined with vascular clip in parametrial management,called limited energy parametrial resection/dissection(LEPRD),in la...Objective: The aim of this study was to investigate the feasibility of using ultrasonic scalpel combined with vascular clip in parametrial management,called limited energy parametrial resection/dissection(LEPRD),in laparoscopic nerve plane-sparing radical hysterectomy(NPSRH),a modified nerve-sparing radical hysterectomy(NSRH); and to evaluate its effectiveness in pelvic autonomic nerve preservation.Methods: From July 2012 to January 2016,257 consecutive patients with stage IB1 to IIA2 cervical cancer who underwent NPSRH were included in this study.Patients were divided into three cohorts according to the different parametrial resection modality.The clinical,pathological and surgery-related parameters were compared between the three groups.Short-and long-term postoperative bladder functions were evaluated.Results: LEPRD was attempted in 94 patients,and was successful in 65(69.1%) patients(LEPRD group).The remaining 29(30.9%) patients required bipolar coagulation after failure of vascular clipping(combined modality group).Routine bipolar cautery was used in the other 163 patients during the parametrial resection(bipolar group).The blood loss in the LEPRD group was significantly lower than those in the other two groups(P<0.001).The rate of successful Foley removal on postoperative day 7 was significantly higher in the LEPRD group than in the bipolar group(P=0.022).The incidence of chronic voiding dysfunction was significantly lower in the LEPRD group than in the bipolar group(P=0.019).Conclusions: It is feasible to perform LEPRD in NPSRH for cervical cancers.This kind of limited energy surgical technique is associated with less blood loss,and leads to improved postoperative bladder function.展开更多
文摘Background In order to simplify the complicated procedure of nerve-sparing radical hysterectomy, a novel technique characterized by integral preservation of the autonomic nerve plane has been employed for invasive cervical cancer. The objective of this study was to introduce the nerve plane-sparing radical hysterectomy technique and compare its efficacy and safety with that of nerve-sparing radical hysterectomy. Methods From September 2006 to August 2010, 73 consecutive patients with International Federation of Gynecology and Obstetrics stage IB to IIA cervical cancer underwent radical hysterectomy with two different nerve-sparing approaches. Nerve-sparing radical hysterectomy was performed for the first 16 patients （nerve-sparing radical hysterectomy group）. The detailed autenomic nerve structures were identified and separated by meticulous dissection during this procedure. After January 2008, the nerve plane-sparing radical hysterectomy procedure was developed and performed for the next 57 patients （nerve plane-sparing radical hysterectomy group）. During this modified procedure, the nerve plane （meso-ureter and its extens;ion） containing most of the autonomic nerve structures was integrally preserved. The patients＇ clinicopathologic characteristics, surgical parameters, and outcomes of postoperative bladder function were compared between the two groups. Results There were no significant differences between the nerve plane-sparing radical hysterectomy and nerve-sparing radical hysterectomy groups regarding age, International Federation of Gynecology and Obstetrics stage, pathological type, preoperative treatment, or need for intraoperative blood transfusion. The nerve plane-sparing radical hysterectomy group had a higher body mass index than that of the nerve-sparing radical hysterectomy group （P=0.028）. The mean surgical duration in the nerve plane-sparing radical hysterectomy and nerve-sparing radical hysterectomy groups were （262_＋46） minutes and （341＋36） minutes （P 〈0.01）.
基金supported by the special fund for Capital City Clinical Specific Application Study(No.Z171100001017115)
文摘Objective: The aim of this study was to investigate the feasibility of using ultrasonic scalpel combined with vascular clip in parametrial management,called limited energy parametrial resection/dissection(LEPRD),in laparoscopic nerve plane-sparing radical hysterectomy(NPSRH),a modified nerve-sparing radical hysterectomy(NSRH); and to evaluate its effectiveness in pelvic autonomic nerve preservation.Methods: From July 2012 to January 2016,257 consecutive patients with stage IB1 to IIA2 cervical cancer who underwent NPSRH were included in this study.Patients were divided into three cohorts according to the different parametrial resection modality.The clinical,pathological and surgery-related parameters were compared between the three groups.Short-and long-term postoperative bladder functions were evaluated.Results: LEPRD was attempted in 94 patients,and was successful in 65(69.1%) patients(LEPRD group).The remaining 29(30.9%) patients required bipolar coagulation after failure of vascular clipping(combined modality group).Routine bipolar cautery was used in the other 163 patients during the parametrial resection(bipolar group).The blood loss in the LEPRD group was significantly lower than those in the other two groups(P<0.001).The rate of successful Foley removal on postoperative day 7 was significantly higher in the LEPRD group than in the bipolar group(P=0.022).The incidence of chronic voiding dysfunction was significantly lower in the LEPRD group than in the bipolar group(P=0.019).Conclusions: It is feasible to perform LEPRD in NPSRH for cervical cancers.This kind of limited energy surgical technique is associated with less blood loss,and leads to improved postoperative bladder function.
