Extended nerve-sparing radical hysterectomy

We have devised a new method of nerve-sparing radical hysterectomy. To raise radicality nerve part of the cardinal ligament above the middle rectal artery is dissected. While to retain bladder function, unilateral the pevic splanchnic nerves, pelvic plexus and bladder branches are preserved. Between November 2001 and August 2004 49 patients with stage IB to IVB cervical carcinoma underwent extended nerve-sparing radical hysterectomy. Tirtythree patients with bilateral complete preservation of the pelvic plexus showed recovery of bladder function as quickly as after the conventional method. Even 16 patients with partial unilateral preservation showed recovery to a residual urine volume of less than 50 ml at a median of 24 days postoperatively. At the median follow-up period of 24 months, local recurrence alone is seen in two patients. None developed pelvic side-wall recurrence. We propose a method of extended nerve-sparing radical hysterectomy to increase radicality.