PT  - JOURNAL ARTICLE
AU  - Tomoyuki Nagai
AU  - Hitoshi Niikura
AU  - Hiroki Kurosawa
AU  - Sota Tanaka
AU  - Takeo Otsuki
AU  - Hiroki Utunomiya
AU  - Satoru Nagase
AU  - Tadao Takano
AU  - Kiyoshi Ito
AU  - Yasuhiro Kaiho
AU  - Haruo Nakagawa
AU  - Yoichi Arai
AU  - Nobuo Yaegashi
TI  - Individualized Radical Hysterectomy Procedure Using Intraoperative Electrical Stimulation for Patients With Cervical Cancer
AID  - 10.1097/IGC.0b013e31826fd684
DP  - 2012 Nov 01
TA  - International Journal of Gynecologic Cancer
PG  - 1591--1596
VI  - 22
IP  - 9
4099  - http://ijgc.bmj.com/content/22/9/1591.short
4100  - http://ijgc.bmj.com/content/22/9/1591.full
SO  - Int J Gynecol Cancer2012 Nov 01; 22
AB  - 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.