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CC BY-NC-ND 4.0 · Surg J (N Y) 2021; 07(S 02): S48-S56
DOI: 10.1055/s-0041-1739119
Precision Surgery in Obstetrics and Gynecology

Nerve-Sparing Radical Hysterectomy Using the Okabayashi–Kobayashi Method

Noriaki Sakuragi
1   Center for Women's Health (Gynecology), Otaru General Hospital, Otaru, Japan
2   Professor Emeritus, Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
,
Masanori Kaneuchi
1   Center for Women's Health (Gynecology), Otaru General Hospital, Otaru, Japan
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Abstract

Radical hysterectomy (RH) is a standard treatment for early-stage cervical cancer. This surgery extirpates the uterus along with the paracervical tissues, vagina, and the paracolpium to achieve local control. Pelvic lymphadenectomy is a critical component of RH performed for regional control. A clear understanding of pelvic anatomy is critical to safely performing a RH and achieving optimal oncological and functional outcomes. The various surgical steps can damage the pelvic autonomic nerves, and a systematic nerve-sparing technique is used for the preservation of autonomic nerves. There is an intricate vascular network in the lateral paracervix (cardinal ligament) and the pelvic sidewall. We need to comprehend the three-dimensional structure of the vascular and nerve anatomy in the pelvis to perform RH effectively and safely. We can create six spaces around the uterine cervix, including the paravesical spaces, pararectal spaces, a vesicovaginal space, and a rectovaginal space to reveal the target of extirpation. It is critical to find the proper tissue plane separated by the layers of membranous connective tissue (fascia), in order to minimize intraoperative bleeding.

Keywords

fascia - paracervical tissues - paracolpium - tissue plane - traction and counter traction


Publication History

Article published online:
01 December 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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