Anatomical And Clinical-related Study Of Modified Nerve-sparing Radical Hysterectomy

Purpose This study was conducted to analyze the distribution of pelvic autonomic nerves at an anatomical level, to compare the nerve plane-sparing radical hysterectomy (NPSRH) with conventional radical hysterectomy (CRH) in terms of postoperative pelvic visceral functions and prognosis, and to assess the feasibility and safety of laporoscopy in NPSRH.Methods Ten female pelvises were dissected in this study to recognize pelvic autonomic nerve from March2013to January2014. Forty-nine patients who underwent laporoscopic NPSRH from July2012to November2013were selected as the laporoscopic NPSRH group. One hundred and two patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB1-IIA2cervical cancer who were treated by open NPSRH from Janurary2008to March2013were selected as open NPSRH group. During the same time periods, two hundred and four patients who underwent open conventional radical hysterectomy (CRH) were randomly selected as the open CRH group. Age, pathological type and stage were matched.Resultsâ‘ Pelvic autonomic nerve plane was recognized in all ten female pelvises. Part of hypogastric nerve run along the ureter to the bladder, and did not communicate with the hypogastric nerve plexus. Of the ten pelvises, two bladder veins were found in seventeen sides, and three bladder veins were found in three sides. The bladder veins run across the pelvic autonomic nerve plane.â‘¡The blood loss volume, blood transfusion rate and postoperative complications were not different between the open NPSRH group and open CRH group (P>0.05). Patients in the open NPSRH group had a significant reduction in terms of duration of catheterization and hospital stay (P=0.000). There was no significant difference between the laporoscopic NPSRH group and open NPSRH group in terms of the age, body mass index, previous surgery, FIGO stage, pathologic type (P>0.05). The mean duration of the surgery in the two groups was not different (P=0.161). Patients in laporoscopic NPSRH group had a significant reduction in blood loss and blood transfusion rate (P<0.01). The median time of catherization and the postoperative stay was significantly shorter in laporoscopic NPSRH group(P<0.05).â‘¢The incidence of long-term urinary frequency, urinary incontinence, urinary retention, straining to void, diarrhea and conspitation was significantly lower in the open NPSRH group (P<0.05). Three-year recurrence-free survival estimate and three-year overall survival estimate was not different between the two groups. Whether sparing nerves or not during radical hysterectomy was not a significant independent predictor by COX regression model analyses.Conclusions The pelvic autonomic nerve resided in a plane, and it had a close relationship with the ureter. The hypogastric nerve may be important primarily for bladder function, but it still remains to be further elucidated by pathology. The bladder vein runs across the pelvic autonomic nerve plane and its variability is great. NPSRH contributes to postoperative bladder function recovery. Both laporoscopic NPSRH and open NPSRH is feasible. And laporoscopic NPSRH is more favorable in terms of blood loss and postoperative bladder function recovery than open NPSRH. NPSRH contributes to long-term bladder and anorectal function recovery without compromising survival.