Introduction In this surgical film, our objective is to review the surgical approach to cervical cancer with a focus on nerve sparing radical hysterectomies. We aim to review specific surgical techniques and considerations for both abdominal and minimally invasive techniques.

Description In today’s video we will review the surgical approach to cervical cancer with a focus on nerve sparing radical hysterectomies. It is important to note that performing a nerve sparing radical hysterectomy does not detract from the radicality of the procedure, but rather describes the technique employed to carefully dissect and preserve the autonomic nerves of the pelvis. Radicality, rather, is determined by the resection of ventral, dorsal, and lateral parametrium. This surgical film will outline the surgical techniques of nerve sparing radical hysterectomy and considerations for abdominal and miminally invasive routes of surgery. Footage is obtained from various cases.

Conclusion/Implications Radical hysterectomy is not just one type of surgery, but rather includes a spectrum of types of resections that balance curative effect with adverse postoperative consequences. Considerations for radical hysterectomy include review of the updated radical hysterectomy system, dissection and identification of key artifical spaces of the pelvis, and use of a laparoscopiic vessel sealing device for abdominal surgeries. Importantly, sentinel lymph node mapping can be utilized in early stage cervical cancer with side specific pelvic lymph node dissection performed for unsuccessful mapping. Lastly, use of a Wertheim clamp or minimally invasive stapling device to prevent spill of cervical cancer cells intra-peritoneally is crucial in this oncologic procedure.