Radical Hysterectomy for Management of Cervical Cancer

Abstract

An alternative to classical radical hysterectomy performed by laparotomy is an endoscopic approach. These procedures can be performed fully by laparoscopy or robotically or in combination with a vaginal approach. Feasibility of both minimally invasive approaches, laparoscopic or robotic surgery, were well proven in early stages, locally advanced stages, old patients, obese patients. An endoscopic approach is associated with less blood loss and shorter hospital stays, but, on the other hand, longer operation times when compared with an open approach. Multiple approaches to performing a radical abdominal hysterectomy and bilateral pelvic lymphadenectomy have been described. The transverse Maylard or Cherney incision is used by some, whereas others prefer midline incisions. Orr and Scribner have reported shorter hospital stays when a Pfannenstiel incision is used. Currie has presented and published a technique using a transverse cosmetic incision with vertical fascial entry for selected patients. Most surgeons prefer a vertical midline incision made 3 cm above the umbilicus and extended inferiorly to the pubic symphysis.