Radical nerve-sparing hysterectomy (type C1)
Epublication WebSurg.com, Feb 2013;13(02). URL: http://websurg.com/doi/vd01en3882
This video demonstrates a nerve-sparing radical hysterectomy (type C1). During type C Radical Hysterectomy (RH), the uterus is removed en bloc with its ligaments along with a vaginal margin of 15 to 20mm. The uterosacral ligaments are transected from the level of the rectum and the vesicouterine ligament at the level of the bladder. The ureter is dissected until it enters the bladder. It is mobilized completely to resect the lateral parametrium from the lateral wall. Radical hysterectomy type C1 implies the preservation of the hypogastric inferior nerve and the bladder branch of the hypogastric plexus during the resection of the parametrium. During the surgery, the components of the hypogastric plexus are identified: the inferior hypogastric nerve running from the lateral wall of the rectum and the splanchnic nerves from S2-S4. The deep uterine vein is an essential landmark because we can find the first splanchnic nerve underneath it. Consequently, during the resection of the posterior parametrium, the uterosacral ligament can be completely resected while conserving the inferior hypogastric nerve. Division of the lateral parametrium is pursued without including the splanchnic nerves. During the transection of the caudal part of the paracervix and the paracolpium, attention must be paid not to include the vesical branch of the inferior hypogastric plexus that runs parallel to paravaginal vessels.