J Gynecol Oncol.  2014 Jul;25(3):198-205. 10.3802/jgo.2014.25.3.198.

Various types of total laparoscopic nerve-sparing radical hysterectomies and their effects on bladder function

Affiliations
  • 1Department of Obstetrics and Gynecology, Kurashiki Medical Center, Kurashiki, Japan. b9g05tn0@ms11.megaegg.ne.jp

Abstract


OBJECTIVE
This study was conducted to ascertain the correlation between preserved pelvic nerve networks and bladder function after laparoscopic nerve-sparing radical hysterectomy.
METHODS
Between 2009 and 2011, 53 patients underwent total laparoscopic radical hysterectomies. They were categorized into groups A, B, and C based on the status of preserved pelvic nerve networks: complete preservation of the pelvic nerve plexus (group A, 27 cases); partial preservation (group B, 13 cases); and complete sacrifice (group C, 13 cases). To evaluate bladder function, urodynamic studies were conducted preoperatively and postoperatively at 1, 3, 6, and 12 months after surgery.
RESULTS
No significant difference in sensory function was found between groups A and B. However, the sensory function of group C was significantly lower than that of the other groups. Group A had significantly better motor function than groups B and C. No significant difference in motor function was found between groups B and C. Results showed that the sensory nerve is distributed predominantly at the dorsal half of the pelvic nerve networks, but the motor nerve is predominantly distributed at the ventral half.
CONCLUSION
Various types of total laparoscopic nerve-sparing radical hysterectomies can be tailored to patients with cervical carcinomas.

Keyword

Bladder function; Cervical cancer; Laparoscopic nerve-sparing radical hysterectomy; Pelvic nerve network; Urodynamic study

MeSH Terms

Adult
Aged
Female
Humans
Hypogastric Plexus/injuries
Hysterectomy/adverse effects/*methods
Laparoscopy/adverse effects/*methods
Middle Aged
Neoplasm Staging
Pelvis/innervation
Peripheral Nerve Injuries/etiology/*prevention & control
Postoperative Period
Urinary Bladder/*innervation/physiopathology
Urodynamics
Uterine Cervical Neoplasms/pathology/*surgery

Figure

  • Fig. 1 Detailed pelvic nerve networks around right parametrium in a fresh cadaver. The pelvic nerve plexus is approximately 3 cm wide, and consists of a hypogastric nerve and pelvic splanchnic nerves.

  • Fig. 2 The pelvic nerve networks of the right side before transecting the cardinal ligament. At this point, the vesical branch of the pelvic nerve plexus is not elucidated.

  • Fig. 3 After transecting the cardinal ligament, the complete structure of the pelvic nerve networks, including the vesical branch, can be elucidated. This figure shows the cutting line of groups A, B, and C.

  • Fig. 4 Function ratio of first desire to void (FDV) and the detrusor contraction pressure at maximum (PdetQmax) at 1, 3, 6, and 12 months after surgery. (A) Group A. (B) Group B. (C) Group C. The standard error of the mean of the function ratio data. p-values are derived from two-tailed tests. The asterisk means not significant. *p≥0.05.

  • Fig. 5 Function ratio of first desire to void (FDV) and the detrusor contraction pressure at maximum (PdetQmax) of groups A, B, and C at 12 months after surgery. The standard error of the mean of the function ratio data. p-values are derived from two-tailed tests. The asterisk means not significant. *p≥0.05.


Cited by  2 articles

Feasibility and outcome of total laparoscopic radical hysterectomy with no-look no-touch technique for FIGO IB1 cervical cancer
Hiroyuki Kanao, Koji Matsuo, Yoichi Aoki, Terumi Tanigawa, Hidetaka Nomura, Sanshiro Okamoto, Nobuhiro Takeshima
J Gynecol Oncol. 2019;30(3):.    doi: 10.3802/jgo.2019.30.e71.

Efficacy and oncologic safety of nerve-sparing radical hysterectomy for cervical cancer: a randomized controlled trial
Ju-Won Roh, Dong Ock Lee, Dong Hoon Suh, Myong Cheol Lim, Sang-Soo Seo, Jinsoo Chung, Sun Lee, Sang-Yoon Park
J Gynecol Oncol. 2015;26(2):90-99.    doi: 10.3802/jgo.2015.26.2.90.


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