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  • Individualized Radical Hysterectomy Procedure Using Intraoperative Electrical Stimulation for Patients With Cervical Cancer

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Surgeons Corner
Individualized Radical Hysterectomy Procedure Using Intraoperative Electrical Stimulation for Patients With Cervical Cancer
  1. Tomoyuki Nagai, MD*,
  2. Hitoshi Niikura, MD, PhD*,
  3. Hiroki Kurosawa, MD*,
  4. Sota Tanaka, MD*,
  5. Takeo Otsuki, MD, PhD*,
  6. Hiroki Utunomiya, MD, PhD*,
  7. Satoru Nagase, MD, PhD*,
  8. Tadao Takano, MD, PhD*,
  9. Kiyoshi Ito, MD, PhD*,
  10. Yasuhiro Kaiho, MD, PhD†,
  11. Haruo Nakagawa, MD, PhD†,
  12. Yoichi Arai, MD, PhD† and
  13. Nobuo Yaegashi, MD, PhD*
  1. *Departments of Obstetrics and Gynecology, and
  2. †Urology, Tohoku University School of Medicine, Sendai, Japan.
  1. Address correspondence and reprint requests to Hitoshi Niikura, MD, PhD, Department of Obstetrics and Gynecology, Tohoku University School of Medicine, 1-1, Seiryo-machi, Sendai 980-8574, Japan. E-mail address: niikura@med.tohoku.ac.jp.

Abstract

Objective In this study, by monitoring the varied distributions of nerve fascicles using intraoperative electrical stimulation (IES), we sought to establish an individualized operation based on the patient’s unique nerve distribution pattern, and to determine whether this technique would result in a higher preservation rate.

Materials/Methods Radical hysterectomy was performed from 2002 to 2010. Patients in group A are the 48 cases from 2002 to 2007 in which nerve-sparing radical hysterectomy using IES as our previous report was performed. Patients in group B are the 38 cases from 2008 to 2010 in which we used our new method, which was individualized to each patient. Urodynamic study (UDS) was used to confirm nerve preservation. Nerve preservation was defined as confirming distinct detrusor contraction during urinary voiding.

Results In group B, nerve preservation rate was higher than in group A (75% vs 9 0%, P = 0.067). We classified the case-by-case nerve anatomy as whether the nerve fascicle was mainly on the medial side or on the lateral side of the deep uterine vein. The lateral type anatomy was observed unilaterally in 6 cases and bilaterally in 1 case. In summary, the lateral type anatomy was observed in 8 (29%) of 28 sides. In the cases evaluated by UDS, the positive predictive value of IES was 95% in group A and 100% in group B.

Conclusions Our method of IES showed a high positive predictive value of nerve preservation as confirmed by UDS. By delineating the nerve tract in detail using IES, it is possible to individualize the operation based on each patient’s anatomy, with an improved nerve preservation rate.

  • Nerve-sparing radical hysterectomy
  • Intraoperative electrical stimulation
  • Urodynamic study
  • Cervical cancer

https://doi.org/10.1097/IGC.0b013e31826fd684

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    Footnotes

    • This work was supported by a Grant-in-Aid from the Kurokawa Cancer Research Foundation; a Grant-in-Aid for Scientific Research on Priority Areas from the Ministry of Education, Science and Culture of Japan; a Grant-in-Aid from the Ministry of Health, Labor and Welfare of Japan; and the 21st Century COE Program Special Research Grant (Tohoku University) from the Ministry of Education Science, Sports and Culture of Japan.

    • The authors declare no conflicts of interest.