Introduction Many clinicians aim to perform adequate parametrial resection, considering that severe bladder dysfunction is a frequent complication after radical hysterectomy. There are no standardized guidelines on whether type 2 or type 3 hysterectomies should be performed. In several institutes, the posterior layer of the vesicouterine ligament is not completely resected in nerve-sparing radical hysterectomy, whereas the vesical vein in the posterior layer of the vesicouterine ligament is resected at the root of the deep uterine vein. Therefore, the present study aimed to compare bladder function and relapse-free survival between classic nerve-sparing radical hysterectomy, in which the posterior leaf of the vesicouterine ligament is completely resected, and simplified nerve-sparing radical hysterectomy, in which only the vesical vein of the posterior layer of the vesicouterine ligament are resected.

Methods This was a single-institution historical cohort study. The surgical procedures varied according to age. We performed the classic nerve-sparing radical hysterectomy with complete resection of the posterior leaf of the vesicouterine ligament, up to 2015. After 2016 we resect only vesical vein of the posterior leaf.

Results There was no significant difference in relapse-free survival between the two surgical procedures. Resection of the posterior layer of the vesicouterine limited to the veins was superior in terms of both motor and sensory bladder functions.

Conclusion/Implications Resection of the posterior layer of the vesicouterine ligament, which is a procedure limited to the veins, is an effective and safe method for radical hysterectomy. It may be more useful for preserving the bladder function without leading to unfavorable oncologic outcomes.