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955 Water-jet dissection in nerve-sparing radical hysterectomy: postoperative outcomes
  1. S Mukhtarulina,
  2. M Meshkova,
  3. O Trushina,
  4. H Maltsagova and
  5. E Novikova
  1. P.A. Hertsen Moscow Oncology Research Center – branch of FSBI NMRRC, the department of gynecologic oncology, Moscow, Russian Federation


Introduction/Background*The development of a nerve-sparing technique of radical hysterectomy leads to a significant functional improvement after surgical treatment of cervical cancer. However, the risk of nerve fibers damage remains high because of difficulties in recognition of elements of the autonomic nervous system. One of approaches for precise nerve dissection is tissue-selective dissection with a water-jet. The main advantage of this method is selective dissection and preservation of nerve fibers and vessels with minimal deformation of the surrounding tissue. This study was aimed to evaluate functional results after nerve sparing radical hysterectomy (RH type C1) in patients with stage IB1-IIA cervical cancer according to the International Federation of Gynecology and Obstetrics (FIGO 2018) staging system.

Methodology Inclusion criteria consisted of the following: histopathologically proven primary cervical cancer of squamous carcinoma, adenocarcinoma or adenosquamous carcinoma, stage IB1-IIA cervical cancer, the lack of preoperative radiation therapy or chemotherapy, ECOG PS 0-1 and normal bladder filling. The main group consisted of 26 patients with stage IB1-IIA cancer after RH type C1 using the water-jet technique. The hypogastric nerve, pelvic splanchnic nerves S2-S4 and vesicular branches of these plexus were selectively isolated under water pressure of 35 Bar. The comparison group A included 79 patients who underwent RH type C1 with the traditional technique. The comparison group B included 52 patients who accepted radical hysterectomy RH type C2.

Result(s)*The average duration of urinary bladder catheterization after surgery in the main group and comparison groups A and B was 2.9±1.8; 6.9±3.8 and 16.1±10.9 days, respectively (p<0.05). The average time for recording of residual urine volume less than 100 ml in the main group amounted to 3.8±1.2 days, in the comparison group A – 10.2±7.5 days, and in the comparison group B – 21.2±20.8 days (p<0.05). In the main group patients had no sign of bladder dysfunction whereas in comparison groups A and B patients encountered these symptoms in 7.6% and 26.2% of cases, respectively (p<0.05).

Conclusion*The first results suggest that using the water-jet technique in tissue incision contributes to the most atraumatic dissection of the autonomic nervous system. Thus, RH type C1 with water-jet dissection result in restoration of lower urinary tract functions in a shorter time.

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