Our Initial Experience of Laparoscopic Nerve Sparing Radical Hysterectomy (LNSRH)

Introduction: Patients undergoing a radical hysterectomy may suffer from urinary and sexual dysfunction as a result of disruption of the pelvic nervous supply. With improvement in screening programs, cancer cervix is being diagnosed at an earlier stage. Hence, the prevention and treatment of these problems becomes especially important.

AIM: To present our initial experience of LNSRH and to show that a Type III radical hysterectomy is possible with a nerve sparing procedure.

MATERIALS AND Methods: A retrospective analysis of 7 patients with early cervical cancer (FIGO Stage I A, n=1 and IB, n=6), who underwent LNSRH at Galaxy Laparoscopy Institute, from January 2007 to March 2008 was done. LNSRH with pelvic lymphadenectomy was performed in all these patients. Hypogastric nerves (sympathetic) were identified medial to the ureter and pelvic splanchnic nerves (parasympathetic) below the uterine vein. These nerves form the inferior hypogastric plexus. The uterine branches of this plexus were selectively cut, preserving the branches to the bladder.

Results: Median operative time was 160 min., median blood loss 250ml. Urinary catheter was removed after 48 hours and median residual volume was 50ml. Two patients had to be recatheterised, but not beyond one month. Uroflowmetric studies after 6 weeks were normal in 5 patients. Average parametrial margin was 2.5 cm and average vaginal cuff length was 3 cm. Four patients reported unaltered sexual activity. Median follow up was 6 months with no recurrences.

Conclusion: Laparoscopic Nerve sparing radical hysterectomy is feasible and may prevent urodynamic problems. Its effectivity with margin status is equivalent to conventional methods