Evolution of nerve-sparing radical hysterectomy: a historical flashback and technical features

Extended radical hysterectomy (RAH) is one of the standard treatments for FIGO stage IA2–IIA cervical cancer (CC). Patients after RAH may develop complications associated with impaired autonomic innervation of the pelvic organs. Bladder and rectal dysfunction is a common complication after the standard radical hysterectomy and can significantly affect quality of life in the patients. Nerve-sparing RAH (NSRH) is a modified RAH designed to preserve the pelvic autonomic nerves, without substantially affecting the radicalness of the operation. The use of NSRH was initially limited due to the difficulties associated with the definition of anatomical structures and lack of data on the oncologic safety of nerve-sparing operations. The complex anatomy of the autonomic nerve plexuses of the pelvis is a sufficient problem for the surgeon, as it requires a comprehensive knowledge of the pelvic anatomy and the characteristics of innervation and blood supply to the cervix, vagina, and parametrial tissue, as well as the practical skills to visualize and select these anatomical structures. Knowledge of the topographic anatomy of the pelvis and a clear visualization of all anatomical regions are the only way to preserve important structures, such as the internal pelvic nerves, pelvic celiac nerves, hypogastric nerves, as well as the branches that fan out from the inferior hypogastric plexus, which innervate the bladder.

Conclusion: RAH makes it possible to maintain quality of life in patients with CC; however, its minimally invasive surgery reduces recurrence-free survival, despite a decline in the number of early postoperative complications and the length of hospital stay. Nevertheless, the role of laparoscopic and robot-assisted hysterectomies in the treatment of early CC continues to be studied worldwide; the categories of patients who can undergo endoscopic surgery having no negative impact on their survival are identified.